hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Newport Community Hospital,8/1/2025,2.0.0,Newport Community Hospital,"714 W. Pine Street, Newport, WA 99156",HAC.FS.00000021,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|ASURIS|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|ASURIS|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|ASURIS|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|ASURIS |ALL_COMMERCIAL_PLANS,standard_charge|ASURIS|ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|ASURIS|ALL_COMMERCIAL_PLANS,standard_charge|AETNA|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|AETNA|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|AETNA|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|AETNA|ALL_COMMERCIAL_PLANS,standard_charge|AETNA|ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|AETNA|ALL_COMMERCIAL_PLANS,standard_charge|BC IDAHO|ALL_PPO_PLANS|negotiated_dollar,standard_charge|BC IDAHO|ALL_PPO_PLANS|negotiated_percentage,standard_charge|BC IDAHO | ALL_PPO_PLANS|negotiated_algorithm,estimated_amount|BC IDAHO | ALL_PPO_PLANS,standard_charge|BC IDAHO| ALL_PPO_PLANS|methodology,additional_payer_notes|BC IDAHO | ALL_PPO_PLANS,standard_charge|BC IDAHO|ALL_HMO_PLANS|negotiated_dollar,standard_charge|BC IDAHO|ALL_HMO_PLANS|negotiated_percentage,standard_charge|BC IDAHO |ALL_HMO_PLANS|negotiated_algorithm,estimated_amount|BC IDAHO | ALL_HMO_PLANS,standard_charge|BC IDAHO| ALL_HMO_PLANS|methodology,additional_payer_notes|BC IDAHO |ALL_HMO_PLANS,standard_charge|BC IDAHO|ALL_TRADITIONAL_PLANS|negotiated_dollar,standard_charge|BC IDAHO|ALL_TRADITIONAL_PLANS|negotiated_percentage,standard_charge|BC IDAHO |ALL_TRADITIONAL_PLANS|negotiated_algorithm,estimated_amount|BC IDAHO | ALL_TRADITIONAL_PLANS,standard_charge|BC IDAHO| ALL_TRADITIONAL_PLANS|methodology,additional_payer_notes|BC IDAHO |ALL_TRADITIONAL_PLANS,standard_charge|BC IDAHO|MEDICARE ADVANTAGE_PLANS|negotiated_dollar,standard_charge|BC IDAHO| MEDICARE ADVANTAGE_PLANS|negotiated_percentage,standard_charge|BC IDAHO | MEDICARE ADVANTAGE_PLANS|negotiated_algorithm,estimated_amount|BC IDAHO | MEDICARE ADVANTAGE_PLANS,standard_charge|BC IDAHO| MEDICARE ADVANTAGE_PLANS|methodology,additional_payer_notes|BC IDAHO | MEDICARE ADVANTAGE_PLANS,standard_charge|CIGNA|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|CIGNA | ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge| CIGNA|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|CIGNA | ALL_COMMERCIAL_PLANS,standard_charge|CIGNA | ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|CIGNA |ALL_COMMERCIAL_PLANS,standard_charge|FIRST CHOICE|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|FIRST CHOICE| ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|FIRST CHOICE|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|FIRST CHOICE | ALL_COMMERCIAL_PLANS,standard_charge|FIRST CHOICE| ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|FIRST CHOICE | ALL_COMMERCIAL_PLANS,standard_charge|MOLINA|MARKETPLACE_PLANS|negotiated_dollar,standard_charge|MOLINA|MARKETPLACE_PLANS|negotiated_percentage,standard_charge|MOLINA|MARKETPLACE_PLANS|negotiated_algorithm,estimated_amount|MOLINA|MARKETPLACE_PLANS,standard_charge|MOLINA|MARKETPLACE_PLANS|methodology,additional_payer_notes|MOLINA|MARKETPLACE_PLANS,standard_charge|MOLINA|MEDICARE_PLANS|negotiated_dollar,standard_charge|MOLINA|MEDICARE_PLANS|negotiated_percentage,standard_charge|MOLINA|MEDICARE_PLANS|negotiated_algorithm,estimated_amount|MOLINA|MEDICARE_PLANS,standard_charge|MOLINA|MEDICARE_PLANS|methodology,additional_payer_notes|MOLINA|MEDICARE_PLANS,standard_charge|MULTIPLAN|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|MULTIPLAN|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|MULTIPLAN|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|MULTIPLAN|ALL_COMMERCIAL_PLANS,standard_charge|MULTIPLAN| ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|MULTIPLAN| ALL_COMMERCIAL_PLANS,standard_charge|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS|negotiated_dollar,standard_charge|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS|negotiated_percentage,standard_charge|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS|negotiated_algorithm,estimated_amount|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS,standard_charge|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS|methodology,additional_payer_notes|PACIFIC SOURCE|MEDICARE ADVANTAGE_PLANS,standard_charge|PREMERA|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|PREMERA|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|PREMERA|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|PREMERA |ALL_COMMERCIAL_PLANS,standard_charge|PREMERA|ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|PREMERA|ALL_COMMERCIAL_PLANS,standard_charge|REGENCE_WA|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|REGENCE_WA|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|REGENCE_WA|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|REGENCE_WA|ALL_COMMERCIAL_PLANS,standard_charge|REGENCE_WA|ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|REGENCE_WA|ALL_COMMERCIAL_PLANS,standard_charge|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS|negotiated_dollar,standard_charge|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS|negotiated_percentage,standard_charge|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS|negotiated_algorithm,estimated_amount|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS,standard_charge|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS|methodology,additional_payer_notes|UNITED HEALTH CARE|ALL_COMMERCIAL_PLANS,standard_charge|UNITED HEALTH CARE|MEDICARE_ADVANTAGE|negotiated_dollar,standard_charge|UNITED HEALTH CARE|MEDICARE_ADVANTAGE|negotiated_percentage,standard_charge|UNITED HEALTH CARE|MEDICARE_ADVANTAGE|negotiated_algorithm,estimated_amount|UNITED HEALTH CARE|MEDICARE_ADVANTAGE,standard_charge|UNITED HEALTH CARE|MEDICARE_ADVANTAGE|methodology,additional_payer_notes|UNITED HEALTH CARE|MEDICARE_ADVANTAGE,standard_charge|min,standard_charge|max,additional_generic_notes
"HC GRAFT TRUNK,ARM,LEG, TOTAL TO 100 SQCM; EA ADDL 25 SQCM",Px00076110221,CDM,15272,CPT,761,RC,,,,BOTH,,,0.01,0.01,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,0.01,
GENTAMICIN SULFATE OPHTH SOLN 0.3%,Rx61314063305,CDM,,,250,RC,61314-0633-05,NDC,,BOTH,1,EA,0.05,0.05,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.04,,,0.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.02,,,0.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.04,,,0.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.02,,,0.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.02,,,0.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.04,,,0.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.02,,,0.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.04,0.05,
LATANOPROST OPHTH SOLN 0.005%,Rx59762033302,CDM,,,250,RC,59762-0333-02,NDC,,BOTH,1,EA,0.06,0.24,0.06,,,0.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.03,,,0.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.06,,,0.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.04,,,0.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.03,,,0.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.06,,,0.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.03,,,0.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.06,,,0.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,,,0.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.03,,,0.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.05,0.06,
ACETAMINOPHEN SUPPOS 650 MG,Rx45802073000,CDM,,,250,RC,45802-0730-00,NDC,,BOTH,650,ME,0.14,0.13,0.13,,,0.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.11,,,0.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.07,,,0.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.1,,,0.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.07,,,0.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.07,,,0.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.12,,,0.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.13,,,0.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.07,,,0.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.11,0.13,
HYOSCYAMINE SULFATE ELIXIR 0.125 MG/5ML,Rx00000006763,CDM,,,250,RC,00000-0067-63,NDC,,BOTH,5,ML,0.21,0.19,0.2,,,0.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.16,,,0.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.1,,,0.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.15,,,0.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.1,,,0.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.1,,,0.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.18,,,0.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.1,,,0.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.16,0.2,
FLUORESCEIN SODIUM OPHTH STRIPS 1 MG,Rx17238090099,CDM,,,250,RC,17238-0900-99,NDC,,BOTH,1,ME,0.22,0.2,0.21,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.17,,,0.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.11,,,0.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.21,,,0.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.16,,,0.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.11,,,0.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.11,,,0.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.19,,,0.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.21,,,0.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.2,,,0.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.11,,,0.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.17,0.21,
BISACODYL SUPPOS 10 MG,Rx00574705012,CDM,,,250,RC,00574-7050-12,NDC,,BOTH,10,ME,0.3,0.27,0.29,,,0.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.23,,,0.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.27,,,0.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.27,,,0.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.27,,,0.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.15,,,0.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.27,,,0.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.29,,,0.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.22,,,0.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.15,,,0.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.28,,,0.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.15,,,0.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.26,,,0.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.29,,,0.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.27,,,0.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.15,,,0.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.23,0.29,
ASPIRIN SUPPOS 600 MG,Rx00574703612,CDM,,,250,RC,00574-7036-12,NDC,,BOTH,600,ME,0.42,0.38,0.4,,,0.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.33,,,0.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.21,,,0.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.4,,,0.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.31,,,0.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.21,,,0.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.39,,,0.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.21,,,0.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.36,,,0.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.4,,,0.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.21,,,0.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.33,0.4,
GENTAMICIN SULFATE OPHTH SOLN 0.3%,Rx24208058060,CDM,,,250,RC,24208-0580-60,NDC,,BOTH,1,EA,0.45,0.41,0.43,,,0.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.35,,,0.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.22,,,0.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.33,,,0.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.22,,,0.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.22,,,0.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.38,,,0.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.41,,,0.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.22,,,0.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.35,0.43,
ACETAMINOPHEN SUPPOS 325 MG,Rx00713016406,CDM,,,250,RC,00713-0164-06,NDC,,BOTH,325,ME,0.6,0.54,0.57,,,0.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.47,,,0.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.54,,,0.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.54,,,0.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.54,,,0.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.29,,,0.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.54,,,0.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.58,,,0.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.44,,,0.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.3,,,0.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.55,,,0.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.29,,,0.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.51,,,0.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.57,,,0.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.54,,,0.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.29,,,0.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.47,0.58,
NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,Rx00378910416,CDM,,,250,RC,00378-9104-16,NDC,,BOTH,0.2,ME,0.63,0.57,0.6,,,0.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.49,,,0.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.57,,,0.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.57,,,0.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.57,,,0.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.31,,,0.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.57,,,0.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.6,,,0.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.46,,,0.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.31,,,0.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.58,,,0.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.31,,,0.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.54,,,0.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.6,,,0.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.57,,,0.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.31,,,0.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.49,0.6,
ATROPINE SULFATE OPHTH SOLN 1%,Rx00065081701,CDM,,,250,RC,00065-0817-01,NDC,,BOTH,1,EA,0.72,0.61,0.68,,,0.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.56,,,0.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.35,,,0.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,,,0.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.53,,,0.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.36,,,0.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.66,,,0.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.35,,,0.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.61,,,0.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.68,,,0.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.35,,,0.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.56,0.69,
HC SPLINT ORTHOGLASS PER/EA INCH,Px00032210WNH,CDM,,,270,RC,,,,BOTH,,,0.75,0.68,0.71,,,0.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.59,,,0.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.68,,,0.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.68,,,0.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.68,,,0.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.37,,,0.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.68,,,0.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.72,,,0.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.55,,,0.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.37,,,0.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.69,,,0.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.37,,,0.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.64,,,0.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.68,,,0.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.37,,,0.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.59,0.72,
ACETAMINOPHEN SUPPOS 120 MG,Rx45802073200,CDM,,,250,RC,45802-0732-00,NDC,,BOTH,120,ME,0.79,0.71,0.75,,,0.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.62,,,0.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.39,,,0.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.76,,,0.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.58,,,0.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.39,,,0.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.73,,,0.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.39,,,0.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.67,,,0.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.75,,,0.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.71,,,0.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.39,,,0.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.62,0.76,
SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%,Rx12870000102,CDM,,,250,RC,12870-0001-02,NDC,,BOTH,1,EA,0.86,0.71,0.82,,,0.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.67,,,0.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.77,,,0.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.77,,,0.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.77,,,0.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.42,,,0.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.77,,,0.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.83,,,0.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.63,,,0.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.42,,,0.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.73,,,0.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.82,,,0.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.77,,,0.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.42,,,0.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.67,0.83,
OFLOXACIN OTIC SOLN 0.3%,Rx70756060915,CDM,,,250,RC,70756-0609-15,NDC,,BOTH,1,EA,0.87,1.69,0.83,,,0.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.68,,,0.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.78,,,0.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.78,,,0.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.78,,,0.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.78,,,0.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.64,,,0.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.74,,,0.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.83,,,0.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.78,,,0.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.68,0.84,
ACETAMINOPHEN SUPPOS 325 MG,Rx51672211600,CDM,,,250,RC,51672-2116-00,NDC,,BOTH,325,ME,0.88,0.79,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,,,0.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.81,,,0.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.75,,,0.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,0.84,
NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,Rx68382030930,CDM,,,250,RC,68382-0309-30,NDC,,BOTH,0.2,ME,0.88,0.79,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,,,0.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.81,,,0.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.75,,,0.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.84,,,0.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.79,,,0.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.43,,,0.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,0.84,
NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,Rx68382030901,CDM,,,250,RC,68382-0309-01,NDC,,BOTH,0.2,ME,0.89,0.8,0.85,,,0.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,,,0.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.85,,,0.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.65,,,0.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.82,,,0.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.76,,,0.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.85,,,0.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.44,,,0.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.69,0.85,
SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%,Rx12870000101,CDM,,,250,RC,12870-0001-01,NDC,,BOTH,1,EA,0.94,0.77,0.89,,,0.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.73,,,0.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.85,,,0.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.85,,,0.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.85,,,0.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.46,,,0.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.85,,,0.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.9,,,0.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.69,,,0.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.47,,,0.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.86,,,0.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.46,,,0.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.8,,,0.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.89,,,0.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.85,,,0.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.46,,,0.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.73,0.9,
NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR,Rx68382031001,CDM,,,250,RC,68382-0310-01,NDC,,BOTH,0.4,ME,1.03,0.93,0.98,,,0.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,,,0.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.5,,,0.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.99,,,0.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.76,,,0.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.51,,,0.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.95,,,0.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.5,,,0.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.88,,,0.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.98,,,0.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.5,,,0.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.8,0.99,
CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT,Rx49884016111,CDM,,,250,RC,49884-0161-11,NDC,,BOTH,200,UN,1.28,2.07,1.22,,,2.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1,,,1.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.15,,,1.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.15,,,1.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.15,,,1.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.63,,,1.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.15,,,2.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.23,,,2.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.94,,,1.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.63,,,1.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.18,,,2.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.63,,,1.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.09,,,1.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.22,,,2.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.15,,,2.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.63,,,0.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1,1.23,
NICOTINE TD PATCH 24HR 21 MG/24HR,Rx68001043490,CDM,,,250,RC,68001-0434-90,NDC,,BOTH,21,ME,1.77,1.59,1.68,,,1.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.38,,,1.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,,,1.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,,,1.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,,,1.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.87,,,0.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,,,1.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.7,,,1.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.3,,,1.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.88,,,0.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.63,,,1.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.87,,,0.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.5,,,1.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.68,,,1.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,,,1.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.87,,,0.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.38,1.7,
NICOTINE TD PATCH 24HR 21 MG/24HR,Rx60505706300,CDM,,,250,RC,60505-7063-00,NDC,,BOTH,21,ME,1.82,1.64,1.73,,,1.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.42,,,1.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.64,,,1.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.64,,,0.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.64,,,1.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.89,,,0.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.64,,,1.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.75,,,1.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.34,,,1.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,0.9,,,1.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.67,,,1.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.89,,,0.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.55,,,1.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.73,,,1.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.64,,,1.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,0.89,,,0.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.42,1.75,
NICOTINE TD PATCH 24HR 7 MG/24HR,Rx60505706100,CDM,,,250,RC,60505-7061-00,NDC,,BOTH,74,ME,1.85,1.67,1.76,,,1.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.44,,,1.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.91,,,0.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.78,,,1.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.36,,,1.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.92,,,0.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.7,,,1.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.91,,,0.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.57,,,1.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.76,,,1.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.91,,,0.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.44,1.78,
NICOTINE TD PATCH 24HR 21 MG/24HR,Rx00536589688,CDM,,,250,RC,00536-5896-88,NDC,,BOTH,21,ME,1.9,1.67,1.81,,,1.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.48,,,1.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.71,,,1.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.71,,,1.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.71,,,1.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.71,,,1.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.82,,,1.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.4,,,1.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.94,,,0.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.75,,,1.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.62,,,1.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.81,,,1.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.71,,,1.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.93,,,0.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.48,1.82,
TIMOLOL MALEATE OPHTH SOLN 0.5% (ONCE-DAILY),Rx68682004525,CDM,,,250,RC,68682-0045-25,NDC,,BOTH,1,EA,2.04,1.79,1.94,,,34.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.59,,,29.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.84,,,31.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.84,,,19.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.84,,,31.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1,,,19.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.84,,,34.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.96,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.5,,,29.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.01,,,29.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.88,,,34.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1,,,19.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.73,,,32.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.94,,,34.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.84,,,36.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1,,,1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.59,1.96,
NICOTINE TD PATCH 24HR 14 MG/24HR,Rx60505706200,CDM,,,250,RC,60505-7062-00,NDC,,BOTH,14,ME,2.13,1.92,2.02,,,2.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.66,,,1.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.92,,,1.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.92,,,1.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.92,,,1.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.04,,,1.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.92,,,1.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.04,,,2.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.57,,,1.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.05,,,1.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.96,,,1.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.04,,,1.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.81,,,1.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.02,,,2.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.92,,,1.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.04,,,1.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.66,2.04,
NICOTINE TD PATCH 24HR 7 MG/24HR,Rx00536589488,CDM,,,250,RC,00536-5894-88,NDC,,BOTH,7,ME,2.14,1.94,2.03,,,2.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,,,1.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.93,,,1.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.93,,,1.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.93,,,1.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.05,,,1.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.93,,,1.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.57,,,1.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.06,,,1.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.97,,,1.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.05,,,1.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.82,,,1.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.03,,,2.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.93,,,1.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.05,,,1.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.67,2.05,
LIDOCAINE PATCH 5%,Rx00591352511,CDM,,,250,RC,00591-3525-11,NDC,,BOTH,1,EA,2.21,1.99,2.1,,,2.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.72,,,1.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.99,,,1.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.99,,,1.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.99,,,1.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.08,,,1.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.99,,,1.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.62,,,1.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.09,,,1.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.03,,,2.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.08,,,1.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.88,,,1.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.1,,,2.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.99,,,1.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.08,,,1.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.72,2.12,
CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT,Rx60505082306,CDM,,,250,RC,60505-0823-06,NDC,,BOTH,200,UN,2.28,0.95,2.17,,,2.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.78,,,1.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.19,,,2.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.68,,,1.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.13,,,1.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.1,,,2.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.94,,,1.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.17,,,2.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.05,,,2.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.78,2.19,
NICOTINE TD PATCH 24HR 14 MG/24HR,Rx00536589533,CDM,,,250,RC,00536-5895-33,NDC,,BOTH,14,ME,2.29,2.06,2.18,,,2.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.79,,,1.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.06,,,2.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.06,,,2.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.06,,,2.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.06,,,2.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.2,,,2.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.68,,,1.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.13,,,1.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.11,,,2.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.95,,,1.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.18,,,2.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.06,,,2.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.12,,,1.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.79,2.2,
NICOTINE TD PATCH 24HR 14 MG/24HR,Rx60505706500,CDM,,,250,RC,60505-7065-00,NDC,,BOTH,14,ME,2.36,2.12,2.24,,,2.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.84,,,1.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.16,,,1.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.27,,,2.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.73,,,1.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.17,,,1.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.17,,,2.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.16,,,1.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.01,,,2.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.24,,,2.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.12,,,2.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.16,,,1.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.84,2.27,
PROMETHAZINE HCL SUPPOS 25 MG,Rx00713052612,CDM,,,250,RC,00713-0526-12,NDC,,BOTH,25,ME,2.41,2.11,2.29,,,4.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.88,,,3.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.17,,,4.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.17,,,2.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.17,,,4.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.18,,,2.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.17,,,4.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.31,,,4.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.77,,,3.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.19,,,3.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.22,,,4.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.18,,,2.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.05,,,4.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.29,,,4.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.17,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.18,,,1.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.88,2.31,
NICOTINE TD PATCH 24HR 14 MG/24HR,Rx68001043388,CDM,,,250,RC,68001-0433-88,NDC,,BOTH,14,ME,2.5,2.25,2.38,,,2.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.95,,,1.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.25,,,2.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.25,,,2.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.25,,,2.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.23,,,1.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.25,,,2.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.4,,,2.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.84,,,1.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.24,,,1.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.3,,,2.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.23,,,1.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.13,,,2.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.38,,,2.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.25,,,2.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1.23,,,1.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1.95,2.4,
BRIMONIDINE TARTRATE OPHTH SOLN 0.2%,Rx70069023101,CDM,,,250,RC,70069-0231-01,NDC,,BOTH,1,EA,3.87,3.48,3.68,,,3.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.02,,,3.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.48,,,3.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.48,,,1.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.48,,,3.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.9,,,1.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.48,,,3.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,3.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,3.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1.92,,,3.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.56,,,3.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.9,,,1.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.29,,,3.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.48,,,3.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1.9,,,1.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,3.72,
HC PR 01991 ANESTH NERVE BLOCK/INJ,Px00096310203,CDM,1991,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01992 ANESTH N BLOCK/INJ PRONE,Px00096310204,CDM,1992,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01990 SUPPORT FOR ORGAN DONOR,Px00096310202,CDM,1990,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01937 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP CRV/THRC CDM,Px00096300013,CDM,1937,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,5.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,4.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,5.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,4.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,5.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01938 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP LMBR/SAC CDM,Px00096300014,CDM,1938,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,5.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,4.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,5.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,4.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,5.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01939 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP CRV/THRC CDM,Px00096300015,CDM,1939,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,5.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,4.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,5.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,4.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,5.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01940 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP LMBR/SAC CDM,Px00096300016,CDM,1940,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,4.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,5.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,4.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,4.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,5.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,2.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,4.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,5.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,5.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01968 ANES/ANALG CS DELIVER ADD-ON,Px00096310200,CDM,1968,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,31.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,33.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,33.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,38.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,31.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,31.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,36.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,34.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,38.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00322 ANESTH BIOPSY OF THYROID,Px00096310025,CDM,322,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01464 ANESTH ANKLE/FT ARTHROSCOPY,Px00096310143,CDM,1464,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01732 ANESTH DX ELBOW ARTHROSCOPY,Px00096310170,CDM,1732,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01820 ANESTH LOWER ARM PROCEDURE,Px00096310180,CDM,1820,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01830 ANESTH LOWER ARM SURGERY,Px00096310182,CDM,1830,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01951 ANESTH BURN LESS 4 PERCENT CDM,Px00096310347,CDM,1951,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00400 ANESTH SKIN EXT/PER/ATRUNK,Px00096310028,CDM,400,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00812 ANES LWR INTST SCR COLSC,Px00096310285,CDM,812,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00940 ANESTH VAGINAL PROCEDURES,Px00096310104,CDM,940,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01380 ANESTH KNEE JOINT PROCEDURE,Px00096310130,CDM,1380,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01382 ANESTH DX KNEE ARTHROSCOPY,Px00096310131,CDM,1382,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01390 ANESTH KNEE AREA PROCEDURE,Px00096310132,CDM,1390,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01470 ANESTH LOWER LEG SURGERY,Px00096310144,CDM,1470,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01480 ANESTH LOWER LEG BONE SURG,Px00096310147,CDM,1480,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01710 ANESTH ELBOW AREA SURGERY,Px00096310165,CDM,1710,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01810 ANESTH LOWER ARM SURGERY,Px00096310179,CDM,1810,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00811 ANES LWR INTST NDSC NOS,Px00096310284,CDM,811,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,57.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,70.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,73.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,70.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,73.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,70.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,57.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,57.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,67.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,62.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00410 ANESTH CORRECT HEART RHYTHM,Px00096310032,CDM,410,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00524 ANESTH CHEST DRAINAGE,Px00096310041,CDM,524,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00635 ANESTH LUMBAR PUNCTURE,Px00096310053,CDM,635,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00702 ANESTH FOR LIVER BIOPSY,Px00096310056,CDM,702,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01200 ANESTH HIP JOINT PROCEDURE,Px00096310112,CDM,1200,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01484 ANESTH LOWER LEG REVISION,Px00096310149,CDM,1484,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01622 ANES DX SHOULDER ARTHROSCOPY,Px00096310158,CDM,1622,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01965 ANESTH INC/MISSED AB PROC,Px00096310198,CDM,1965,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01966 ANESTH INDUCED AB PROCEDURE,Px00096310235,CDM,1966,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00532 ANESTH VASCULAR ACCESS,Px00096310045,CDM,532,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00750 ANESTH REPAIR OF UPPER HERNIA,Px00096310059,CDM,750,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00830 ANESTH REPAIR OF INGUINAL HERNIA,Px00096310072,CDM,830,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00942 ANESTH SURG ON VAG/URETHRAL,Px00096310105,CDM,942,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00952 ANESTH HYSTEROSCOPE/GRAPH,Px00096310109,CDM,952,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01202 ANESTH ARTHROSCOPY OF HIP,Px00096310113,CDM,1202,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01320 ANESTH KNEE AREA SURGERY,Px00096310127,CDM,1320,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01340 ANESTH KNEE AREA PROCEDURE,Px00096310128,CDM,1340,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01392 ANESTH KNEE AREA SURGERY TIB/FIB/UPPER,Px00096310133,CDM,1392,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01400 ANESTH KNEE AREA SURGERY ARTHROSCOPY,Px00096310134,CDM,1400,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01620 ANESTH SHOULDER PROCEDURE,Px00096310157,CDM,1620,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01740 ANESTH UPPER ARM SURGERY,Px00096310171,CDM,1740,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00834 ANESTH HERNIA REPAIR < 1 YR,Px00096310074,CDM,834,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00916 ANESTH BLEEDING CONTROL,Px00096310096,CDM,916,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01112 ANESTH BONE ASPIRATE/BX,Px00096310110,CDM,1112,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01360 ANESTH KNEE AREA SURGERY,Px00096310129,CDM,1360,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01472 ANESTH ACHILLES TENDON SURG,Px00096310145,CDM,1472,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01958 ANESTH ANTEPARTUM MANIPUL,Px00096310193,CDM,1958,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01960 ANESTH VAGINAL DELIVERY,Px00096310194,CDM,1960,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01967 ANESTH/ANALG VAG DELIVERY,Px00096310199,CDM,1967,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01969 ANESTH/ANALG CS HYST ADD-ON,Px00096310201,CDM,1969,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00402 ANESTH SURGERY OF BREAST,Px00096310029,CDM,402,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00450 ANESTH SURGERY OF SHOULDER,Px00096310033,CDM,450,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00731 ANES UPPR GI NDSC PX NOS,Px00096310282,CDM,731,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00813 ANES UPPR LWR GI NDSC PX,Px00096310286,CDM,813,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00902 ANESTH ANORECTAL SURGERY,Px00096310089,CDM,902,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00950 ANESTH VAGINAL ENDOSCOPY,Px00096310108,CDM,950,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01474 ANESTH LOWER LEG SURGERY,Px00096310146,CDM,1474,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01610 ANESTH SURGERY OF SHOULDER AND AXILLA,Px00096310156,CDM,1610,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01630 ANESTH SURGERY OF SHOULDER OPEN OR SURGICAL ARTHRO,Px00096310159,CDM,1630,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00836 ANESTH HERNIA REPAIR PREEMIE QZ,Px00096310213,CDM,836,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00944 ANESTH VAGINAL HYSTERECTOMY,Px00096310106,CDM,944,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01210 ANESTH HIP JOINT SURGERY,Px00096310114,CDM,1210,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00732 ANES UPR GI NDSC PX ERCP,Px00096310283,CDM,732,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00752 ANESTH REPAIR OF HERNIA VENTRIL &INCISION,Px00096310060,CDM,752,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00832 ANESTH REPAIR OF HERNIA VENTRI&INCISION,Px00096310073,CDM,832,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00851 ANESTH TUBAL LIGATION,Px00096310079,CDM,846,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00534 ANESTH CARDIOVERTER/DEFIB,Px00096310046,CDM,534,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00754 ANESTH REPAIR UPPER ABD; OMPHALOCELE,Px00096310061,CDM,754,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00756 ANESTH REPAIR OF HERNIA UPPER ABD; TRANSABD OF DIAPH,Px00096310062,CDM,756,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01922 ANESTH CAT OR MRI SCAN,Px00096310190,CDM,1922,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01961 ANESTH CS DELIVERY,Px00096310195,CDM,1961,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00632 ANESTH LUMBAR REGION,Px00096310251,CDM,632,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00790 ANESTH SURG UPPER ABDOMEN,Px00096310064,CDM,790,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00904 ANESTH PERINEAL SURGERY,Px00096310090,CDM,904,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01402 ANESTH TOTAL KNEE ARTHROPLASTY,Px00096310135,CDM,1402,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01486 ANESTH ANKLE REPLACEMENT,Px00096310150,CDM,1486,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01962 ANESTH EMER HYSTERECTOMY,Px00096310196,CDM,1962,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01963 ANESTH CS HYSTERECTOMY,Px00096310197,CDM,1963,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00846 ANESTH HYSTERECTOMY,Px00096310077,CDM,846,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01214 ANESTH HIP ARTHROPLASTY,Px00096310116,CDM,1214,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01212 ANESTH HIP DISARTICULATION,Px00096310115,CDM,1212,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01215 ANESTH REVISE HIP REPAIR,Px00096310117,CDM,1215,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 01638 ANESTH SHOULDER REPLACEMENT,Px00096310161,CDM,1638,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,169.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,177.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,169.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,177.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
HC PR 00770 ANESTH BLOOD VESSEL REPAIR,Px00096310063,CDM,770,CPT,963,RC,,,,BOTH,,,5.73,5.16,3.21,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.04,,,205.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,219.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.58,,,219.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.15,,,253.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,205.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,205.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,242.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.72,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.27,,,224.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3.72,,,250.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,2.69,3.72,EACH MINUTE ADD ON TO  BASE FEE
SILVER SULFADIAZINE CREAM 1%,Rx67877012425,CDM,,,250,RC,67877-0124-25,NDC,,BOTH,1,EA,4.52,3.45,4.29,,,4.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.53,,,3.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.21,,,2.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.32,,,3.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.24,,,2.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.16,,,4.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.21,,,2.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.84,,,3.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.29,,,4.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.21,,,2.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.53,4.34,
ACETAMINOPHEN SUPPOS 120 MG,Rx51672211502,CDM,,,250,RC,51672-2115-02,NDC,,BOTH,120,ME,4.57,3.09,4.34,,,4.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.56,,,3.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.24,,,2.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.36,,,3.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.26,,,2.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.2,,,4.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.24,,,2.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.88,,,3.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.24,,,2.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.56,4.39,
HC ISOVUE 300 30ML,Sx00000131525,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC POUCH ACTIVE LIFE 1-PIECE DRAINABLE,Sx00000022771,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC ISOVUE 300 50ML,Sx00000131530,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC ARMBOARD ADULT 3X17.5 DISP LONG,Sx000045-0002,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC ARMBOARD ADULT 3X9 DISP SHORT,Sx00000138174,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC ARMBOARD NEO-NATAL 1X4 DISP FOAM,Sx45008-11-MP,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC SPONGE X-RAY DETECT VISTEC BANDED 10 PER PACK,Sx00000007318,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC SPONGE DENTAL ROLL STERILE 1.5X3/8,Sx0000031-207,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC DRESSING XEROFORM 5X9 STERILE PETROLATUM,Sx08884431605,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC OSTOMY CLAMP POUCH,Sx00000175635,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC DRESSING XEROFORM 1X8 PETROLATIUM,Sx000DKC77034,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC NEEDLE ELECTROSURGICAL STERILE,Sx00000138102,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC OSTOMY VENTED POUCH HOLLISTER,Sx00000008331,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
HC OSTOMY BARRIER RING BAR FTR RING VENTED OSTOMY POUCH,Sx00000007805,CDM,,,270,RC,,,,BOTH,,,5,4.5,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.9,,,3.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,2.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.68,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.47,,,3.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.75,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.45,,,2.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.9,4.8,
TRIAMCINOLONE ACETONIDE CREAM 0.1%,Rx67877025180,CDM,,,250,RC,67877-0251-80,NDC,,BOTH,1,EA,5.15,3.74,4.89,,,4.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.52,,,2.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.94,,,4.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.79,,,3.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.55,,,2.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.74,,,4.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.52,,,2.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.52,,,2.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,4.94,
"HC INFANT ARMBOARD 1""X 5"" 4",Px00003368WNH,CDM,,,270,RC,,,,BOTH,,,5.17,4.65,4.91,,,4.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.03,,,4.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.65,,,4.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.65,,,2.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.65,,,4.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.53,,,2.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.65,,,4.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.96,,,4.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.8,,,4.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.56,,,4.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.76,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.53,,,2.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.39,,,4.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.91,,,4.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.65,,,4.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.53,,,2.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.03,4.96,
HC ADULT SHORT ARMBOARD,Px00003367WNH,CDM,,,270,RC,,,,BOTH,,,5.41,4.87,5.14,,,4.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.22,,,4.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,4.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,2.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,4.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.65,,,2.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,4.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.98,,,4.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.68,,,4.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.98,,,4.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.65,,,2.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.6,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,4.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,5.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.65,,,2.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.22,5.19,
"HC DRESSING XEROFORM 5X9""",Px00005608WNH,CDM,,,270,RC,,,,BOTH,,,5.42,4.88,5.15,,,4.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.23,,,4.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.88,,,4.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.88,,,2.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.88,,,4.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.66,,,2.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.88,,,4.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.98,,,4.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.68,,,4.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.99,,,4.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.66,,,2.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.61,,,4.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.15,,,4.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.88,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.66,,,2.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.23,5.2,
GENTAMICIN SULFATE OPHTH SOLN 0.3%,Rx60758018805,CDM,,,250,RC,60758-0188-05,NDC,,BOTH,1,EA,5.48,4.93,5.21,,,4.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.27,,,4.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,4.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,2.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,4.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.03,,,4.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.71,,,4.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.04,,,5.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.66,,,4.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,4.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,5.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.27,5.26,
CLONAZEPAM TAB 1 MG,Rx43547040710,CDM,,,250,RC,43547-0407-10,NDC,,BOTH,1,ME,5.61,5.05,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.12,,,4.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,5.39,
DIAZEPAM TAB 5 MG,Rx00904588061,CDM,,,250,RC,00904-5880-61,NDC,,BOTH,5,ME,5.62,5.06,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.13,,,4.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.78,,,4.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,5.4,
DIAZEPAM TAB 5 MG,Rx51079028501,CDM,,,250,RC,51079-0285-01,NDC,,BOTH,5,ME,5.62,5.06,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.13,,,4.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.78,,,4.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.75,,,2.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,5.4,
TRAMADOL HCL TAB 50 MG,Rx00904636561,CDM,,,250,RC,00904-6365-61,NDC,,BOTH,50,ME,5.63,5.07,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.14,,,4.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.79,,,4.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,5.4,
DIAZEPAM TAB 5 MG,Rx51079028520,CDM,,,250,RC,51079-0285-20,NDC,,BOTH,5,ME,5.63,5.07,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.14,,,4.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.79,,,4.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,5.4,
LORAZEPAM TAB 1 MG,Rx69315090501,CDM,,,250,RC,69315-0905-01,NDC,,BOTH,1,ME,5.64,5.06,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.41,,,5.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.15,,,4.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.19,,,5.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.79,,,4.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.76,,,2.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,5.41,
CLONAZEPAM TAB 1 MG,Rx60687055511,CDM,,,250,RC,60687-0555-11,NDC,,BOTH,1,ME,5.65,5.09,5.37,,,5.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,,,4.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.42,,,5.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.15,,,4.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.8,,,2.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.2,,,5.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.37,,,5.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,5.42,
LORAZEPAM TAB 1 MG,Rx00904600861,CDM,,,250,RC,00904-6008-61,NDC,,BOTH,1,ME,5.65,5.09,5.37,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.41,,,4.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,2.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.42,,,5.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.15,,,4.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,4.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.37,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,5.42,
HC ADULT LONG ARMBOARD,Px00003366WNH,CDM,,,270,RC,,,,BOTH,,,5.66,5.09,5.38,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.41,,,4.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,2.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.43,,,5.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.16,,,4.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,4.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,4.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,5.43,
HYDROMORPHONE HCL TAB 4 MG,Rx42858030225,CDM,,,250,RC,42858-0302-25,NDC,,BOTH,4,ME,5.66,5.09,5.38,,,5.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.41,,,4.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,4.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.43,,,5.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.16,,,4.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,4.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.09,,,5.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.77,,,2.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,5.43,
CHLORDIAZEPOXIDE HCL CAP 25 MG,Rx00555015904,CDM,,,250,RC,00555-0159-04,NDC,,BOTH,25,ME,5.67,5.1,5.39,,,5.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.42,,,4.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,4.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,2.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,4.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.78,,,2.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,5.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.44,,,5.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.17,,,4.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.81,,,4.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,5.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.78,,,2.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.82,,,4.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,5.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.42,5.44,
CHLORDIAZEPOXIDE HCL CAP 25 MG,Rx00555015902,CDM,,,250,RC,00555-0159-02,NDC,,BOTH,25,ME,5.68,5.1,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.43,,,4.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,,,5.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.17,,,4.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.23,,,5.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.83,,,4.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.4,,,5.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.78,,,2.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.43,5.45,
ZOLPIDEM TARTRATE TAB 5 MG,Rx68084018911,CDM,,,250,RC,68084-0189-11,NDC,,BOTH,5,ME,5.7,5.13,5.42,,,5.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.45,,,4.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.13,,,5.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.13,,,5.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.13,,,5.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.13,,,5.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.19,,,4.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.24,,,5.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.85,,,4.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.42,,,5.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.13,,,5.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.45,5.47,
ZOLPIDEM TARTRATE TAB 5 MG,Rx00904608261,CDM,,,250,RC,00904-6082-61,NDC,,BOTH,5,ME,5.7,5.11,5.42,,,5.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.45,,,4.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,4.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,2.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,4.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,5.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.47,,,5.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.19,,,4.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,4.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.24,,,5.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.85,,,4.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.42,,,5.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.45,5.47,
TEMAZEPAM CAP 15 MG,Rx00228207610,CDM,,,250,RC,00228-2076-10,NDC,,BOTH,15,ME,5.7,5.13,5.42,,,5.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.45,,,4.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,2.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,4.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,5.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.47,,,5.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.19,,,4.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,4.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.24,,,5.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.85,,,4.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.42,,,5.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,5.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.79,,,2.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.45,5.47,
MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),Rx00054051744,CDM,,,250,RC,00054-0517-44,NDC,,BOTH,5,ML,5.71,5.11,5.42,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.45,,,4.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,2.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.48,,,5.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.2,,,4.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.83,,,4.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.25,,,5.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,2.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.85,,,4.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.42,,,5.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,5.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.8,,,2.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.45,5.48,
TEMAZEPAM CAP 15 MG,Rx67877014601,CDM,,,250,RC,67877-0146-01,NDC,,BOTH,15,ME,5.72,5.15,5.43,,,5.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.46,,,4.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.8,,,2.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.2,,,4.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.83,,,2.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.8,,,2.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,,,4.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.43,,,5.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.8,,,2.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.46,5.49,
HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG,Rx00406012401,CDM,,,250,RC,00406-0124-01,NDC,,BOTH,1,EA,5.73,5.16,5.44,,,5.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.47,,,4.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.5,,,5.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.21,,,4.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.87,,,4.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.44,,,5.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.47,5.5,
METHADONE HCL TAB 10 MG,Rx00904653061,CDM,,,250,RC,00904-6530-61,NDC,,BOTH,10,ME,5.73,5.15,5.44,,,5.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.47,,,4.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.5,,,5.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.21,,,4.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.87,,,4.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.44,,,5.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.47,5.5,
HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG,Rx50268040211,CDM,,,250,RC,50268-0402-11,NDC,,BOTH,1,EA,5.74,5.17,5.45,,,5.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.48,,,4.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.51,,,5.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.22,,,4.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.28,,,5.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.88,,,4.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,,,5.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.17,,,5.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.81,,,2.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.48,5.51,
HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG,Rx00904682461,CDM,,,250,RC,00904-6824-61,NDC,,BOTH,1,EA,5.75,5.18,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,,,4.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.52,,,5.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.23,,,4.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.85,,,2.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.29,,,5.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,5.52,
OXYCODONE HCL TAB 5 MG,Rx42858000101,CDM,,,250,RC,42858-0001-01,NDC,,BOTH,5,ME,5.76,5.12,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,,,4.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.53,,,5.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.23,,,4.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.85,,,2.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.3,,,5.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.9,,,4.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,5.53,
LATANOPROST OPHTH SOLN 0.005%,Rx70069042101,CDM,,,250,RC,70069-0421-01,NDC,,BOTH,1,EA,5.76,5.18,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,,,4.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.53,,,5.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.23,,,4.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.85,,,2.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.3,,,5.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.9,,,4.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,5.53,
"HC TAPE SILICONE 1""BLUE",Px00009495WNH,CDM,,,270,RC,,,,BOTH,,,5.76,5.18,5.47,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,2.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,5.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.53,,,5.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.23,,,4.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.85,,,4.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.3,,,5.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.9,,,4.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.47,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,5.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,5.53,
ACETAMINOPHEN W/ CODEINE TAB 300-30 MG,Rx00406048423,CDM,,,250,RC,00406-0484-23,NDC,,BOTH,1,EA,5.76,5.18,5.47,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,2.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,4.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.53,,,5.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.23,,,4.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.85,,,4.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.3,,,5.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.9,,,4.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.47,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.18,,,5.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.82,,,2.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.49,5.53,
PREGABALIN CAP 75 MG,Rx00904700061,CDM,,,250,RC,00904-7000-61,NDC,,BOTH,75,ME,5.78,5.2,5.49,,,5.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.51,,,4.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,3.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.83,,,3.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.55,,,5.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.86,,,4.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,5.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.83,,,3.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.91,,,5.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.49,,,5.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.2,,,5.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.83,,,2.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.51,5.55,
PHENOBARBITAL TAB 32.4 MG,Rx00904657561,CDM,,,250,RC,00904-6575-61,NDC,,BOTH,32.4,ME,5.79,5.21,5.5,,,5.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.52,,,4.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,3.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,3.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.56,,,5.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.26,,,4.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.87,,,4.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.33,,,5.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,3.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.92,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,5.56,
HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG,Rx00904682661,CDM,,,250,RC,00904-6826-61,NDC,,BOTH,1,EA,5.8,5.22,5.51,,,5.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,,,4.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.26,,,4.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.93,,,4.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.51,,,5.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,5.57,
BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV),Rx42858050203,CDM,,,250,RC,42858-0502-03,NDC,,BOTH,8,ME,5.8,5.22,5.51,,,5.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,,,4.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.26,,,4.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.93,,,4.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.51,,,5.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,5.57,
LORAZEPAM CONC 2 MG/ML,Rx00054353244,CDM,,,250,RC,00054-3532-44,NDC,,BOTH,1,ML,5.8,5.21,5.51,,,5.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.52,,,4.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,4.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,2.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,4.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,2.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,5.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.26,,,4.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.87,,,4.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,5.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,2.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.93,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.51,,,5.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,5.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.84,,,2.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.52,5.57,
DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG,Rx62559049001,CDM,,,250,RC,62559-0490-01,NDC,,BOTH,1,EA,5.83,5.25,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.55,,,4.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.25,,,5.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.25,,,5.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.25,,,5.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.25,,,5.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.6,,,5.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.29,,,4.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.89,,,2.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.96,,,4.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.25,,,5.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.55,5.6,
CHLORDIAZEPOXIDE HCL CAP 25 MG,Rx51079014101,CDM,,,250,RC,51079-0141-01,NDC,,BOTH,25,ME,5.84,5.26,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.56,,,4.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.29,,,4.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.89,,,2.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.37,,,5.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.96,,,4.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.86,,,2.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.56,5.61,
HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG,Rx60687040711,CDM,,,250,RC,60687-0407-11,NDC,,BOTH,1,EA,5.85,5.27,5.56,,,5.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.56,,,4.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.97,,,4.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.56,,,5.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.56,5.62,
HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG,Rx00904682561,CDM,,,250,RC,00904-6825-61,NDC,,BOTH,1,EA,5.86,5.27,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.57,,,4.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.63,,,5.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.31,,,4.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.98,,,4.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.57,5.63,
HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG,Rx00406012323,CDM,,,250,RC,00406-0123-23,NDC,,BOTH,1,EA,5.86,5.27,5.57,,,5.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.57,,,4.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,5.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,3.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,5.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.87,,,3.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,5.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.63,,,5.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.31,,,4.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.9,,,4.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.87,,,3.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.98,,,5.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.57,,,5.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,5.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.87,,,2.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.57,5.63,
OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG,Rx00904643761,CDM,,,250,RC,00904-6437-61,NDC,,BOTH,1,EA,5.91,5.32,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.61,,,4.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.32,,,5.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.32,,,5.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.32,,,5.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.32,,,5.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.67,,,5.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.44,,,5.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.02,,,5.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.32,,,5.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.61,5.67,
PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML,Rx60432060616,CDM,,,250,RC,60432-0606-16,NDC,,BOTH,5,ML,5.92,5.33,5.62,,,5.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.62,,,4.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.68,,,5.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.93,,,2.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,,,5.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.03,,,5.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.9,,,2.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.62,5.68,
OXYCODONE HCL TAB 5 MG,Rx00904696661,CDM,,,250,RC,00904-6966-61,NDC,,BOTH,5,ME,5.93,5.34,5.63,,,5.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.63,,,4.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,4.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,3.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,4.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.91,,,3.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,5.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.69,,,5.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.36,,,4.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2.93,,,4.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.91,,,3.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.04,,,5.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.63,,,5.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.34,,,5.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.91,,,2.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.63,5.69,
ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,Rx00121050404,CDM,,,250,RC,00121-0504-04,NDC,,BOTH,5,ML,5.94,5.27,5.64,,,5.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.63,,,4.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.91,,,2.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.7,,,5.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.94,,,2.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.91,,,2.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.05,,,5.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.64,,,5.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.91,,,2.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.63,5.7,
METHADONE HCL TAB 5 MG,Rx60687021411,CDM,,,250,RC,60687-0214-11,NDC,,BOTH,5,ME,5.95,5.36,5.65,,,5.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,,,4.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.71,,,5.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.94,,,2.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.47,,,5.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,,,5.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.65,,,5.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.64,5.71,
HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG,Rx60687039611,CDM,,,250,RC,60687-0396-11,NDC,,BOTH,1,EA,5.96,5.36,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.65,,,4.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.72,,,5.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.95,,,2.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.48,,,5.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.07,,,5.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.36,,,5.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.92,,,2.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.65,5.72,
METHADONE HCL TAB 5 MG,Rx00054070920,CDM,,,250,RC,00054-0709-20,NDC,,BOTH,5,ME,5.98,5.38,5.68,,,5.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.66,,,4.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.93,,,2.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.74,,,5.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2.96,,,2.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.5,,,5.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.93,,,2.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.08,,,5.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.68,,,5.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.38,,,5.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.93,,,2.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.66,5.74,
TIMOLOL MALEATE OPHTH SOLN 0.5%,Rx61314022705,CDM,,,250,RC,61314-0227-05,NDC,,BOTH,1,EA,6.06,5.32,5.76,,,5.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.73,,,4.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,3.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,3.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,5.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.82,,,5.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.45,,,4.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3,,,4.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.58,,,5.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,3.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.15,,,5.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.76,,,5.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,5.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,2.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.73,5.82,
MORPHINE SULFATE TAB 15 MG,Rx00054023524,CDM,,,250,RC,00054-0235-24,NDC,,BOTH,15,ME,6.07,5.46,5.77,,,5.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.73,,,5.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,3.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,3.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,5.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.83,,,6.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.46,,,5.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3,,,5.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.58,,,6.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,3.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.16,,,5.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.77,,,5.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,6.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.97,,,2.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.73,5.83,
MODAFINIL TAB 200 MG,Rx62332038630,CDM,,,250,RC,62332-0386-30,NDC,,BOTH,200,ME,6.1,5.33,5.8,,,5.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.76,,,4.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.99,,,2.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.86,,,5.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.48,,,4.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.99,,,2.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.19,,,5.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.8,,,5.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.49,,,5.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2.99,,,2.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.76,5.86,
DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG,Rx59762106101,CDM,,,250,RC,59762-1061-01,NDC,,BOTH,1,EA,6.11,5.5,5.8,,,5.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.77,,,4.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,3.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.99,,,3.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.87,,,5.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.02,,,4.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.62,,,5.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.99,,,3.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.8,,,5.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2.99,,,2.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,5.87,
OXYCODONE HCL TAB 5 MG,Rx42858000110,CDM,,,250,RC,42858-0001-10,NDC,,BOTH,5,ME,6.16,5.51,5.85,,,5.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.8,,,4.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.91,,,5.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.53,,,4.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.05,,,3.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.67,,,5.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.24,,,5.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.85,,,5.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.8,5.91,
PREGABALIN CAP 75 MG,Rx60687049511,CDM,,,250,RC,60687-0495-11,NDC,,BOTH,75,ME,6.17,5.55,5.86,,,5.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.81,,,4.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.92,,,5.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.53,,,4.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.05,,,3.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.68,,,5.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.24,,,5.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.86,,,5.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.02,,,3.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.81,5.92,
MUPIROCIN OINT 2%,Rx51672131200,CDM,,,250,RC,51672-1312-00,NDC,,BOTH,1,EA,6.23,5.45,5.92,,,5.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,,,4.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.05,,,3.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.98,,,5.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.58,,,4.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.08,,,3.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.73,,,5.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.05,,,3.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.3,,,5.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.92,,,5.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.05,,,3.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,5.98,
TOBRAMYCIN OPHTH SOLN 0.3%,Rx70069013101,CDM,,,250,RC,70069-0131-01,NDC,,BOTH,1,EA,6.27,5.65,5.96,,,5.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.89,,,4.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.64,,,5.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.64,,,3.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.64,,,5.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.07,,,3.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.64,,,5.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.02,,,6.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.61,,,4.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.1,,,4.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.77,,,5.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.07,,,3.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.33,,,5.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,5.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.64,,,5.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.07,,,3.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,6.02,
HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,Rx00121077204,CDM,,,250,RC,00121-0772-04,NDC,,BOTH,15,ML,6.29,5.66,5.98,,,5.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.91,,,4.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.08,,,3.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.04,,,6.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.62,,,4.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.11,,,3.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.79,,,5.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.08,,,3.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.35,,,5.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.98,,,5.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.08,,,3.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.91,6.04,
MORPHINE SULFATE TAB ER 30 MG,Rx00904655861,CDM,,,250,RC,00904-6558-61,NDC,,BOTH,30,ME,6.29,5.65,5.98,,,6.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.91,,,5.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,5.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,3.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,5.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.08,,,3.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,6.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.04,,,6.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.62,,,5.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.11,,,5.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.79,,,6.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.08,,,3.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.35,,,5.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.98,,,6.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,6.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.08,,,3.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.91,6.04,
MORPHINE SULFATE TAB ER 15 MG,Rx00904655761,CDM,,,250,RC,00904-6557-61,NDC,,BOTH,15,ME,6.31,5.67,5.99,,,5.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.92,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,5.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,3.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,5.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,3.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,5.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.06,,,6.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.64,,,4.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.12,,,4.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,3.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.36,,,5.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.99,,,5.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.09,,,3.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.92,6.06,
ALPRAZOLAM ORALLY DISINTEGRATING TAB 0.5 MG,Rx49884011152,CDM,,,250,RC,49884-0111-52,NDC,,BOTH,0.5,ME,6.38,5.74,6.06,,,6.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.98,,,5.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.74,,,5.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.74,,,3.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.74,,,5.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.13,,,3.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.74,,,6.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.12,,,6.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.69,,,5.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.16,,,5.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.87,,,6.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.13,,,3.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.42,,,6.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.06,,,6.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.74,,,6.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.13,,,3.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.98,6.12,
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,Rx00115146853,CDM,,,250,RC,,,,BOTH,1,EA,6.42,5.78,6.1,,,6.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.01,,,5.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.16,,,6.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.72,,,4.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.18,,,3.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.91,,,5.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.1,,,6.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.01,6.16,
MORPHINE SULFATE TAB ER 15 MG,Rx68084015711,CDM,,,250,RC,68084-0157-11,NDC,,BOTH,15,ME,6.42,5.78,6.1,,,6.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.01,,,5.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.16,,,6.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.72,,,4.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.18,,,3.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.91,,,5.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.1,,,6.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.15,,,3.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.01,6.16,
PREGABALIN CAP 50 MG,Rx60687048411,CDM,,,250,RC,60687-0484-11,NDC,,BOTH,50,ME,6.45,5.81,6.13,,,6.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.03,,,5.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.16,,,3.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.19,,,6.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.74,,,4.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.19,,,3.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.93,,,5.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.16,,,3.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.48,,,5.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.13,,,6.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.81,,,5.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.16,,,3.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.03,6.19,
PROMETHAZINE HCL SUPPOS 12.5 MG,Rx00713053606,CDM,,,250,RC,00713-0536-06,NDC,,BOTH,12.5,ME,6.49,5.84,6.17,,,5.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.06,,,5.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.84,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.84,,,3.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.84,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.18,,,3.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.84,,,5.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.23,,,6.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.77,,,5.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.21,,,5.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.97,,,5.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.18,,,3.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.52,,,5.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.17,,,5.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.84,,,6.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.18,,,3.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.06,6.23,
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG,Rx00904643861,CDM,,,250,RC,00904-6438-61,NDC,,BOTH,1,EA,6.52,5.87,6.19,,,6.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.87,,,5.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.87,,,5.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.87,,,5.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.19,,,3.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.87,,,5.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.26,,,6.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.79,,,4.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.23,,,3.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6,,,6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.19,,,3.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.54,,,5.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.19,,,6.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.87,,,5.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.19,,,3.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,6.26,
HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML,Rx50383004316,CDM,,,250,RC,50383-0043-16,NDC,,BOTH,5,ML,6.53,5.88,6.2,,,6.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,,,5.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.88,,,5.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.88,,,5.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.88,,,5.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.2,,,3.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.88,,,5.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.27,,,6.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.8,,,4.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.23,,,3.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.01,,,6.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.2,,,3.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.55,,,5.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.2,,,6.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.88,,,5.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.2,,,3.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.09,6.27,
PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML,Rx00000002475,CDM,,,250,RC,00000-0024-75,NDC,,BOTH,5,ML,6.54,5.89,6.21,,,5.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.1,,,4.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.89,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.89,,,3.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.89,,,5.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.2,,,3.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.89,,,5.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.28,,,5.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,4.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.24,,,4.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.02,,,5.745,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.2,,,3.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.56,,,5.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.21,,,5.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.89,,,5.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.2,,,3.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.1,6.28,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx00832046515,CDM,,,250,RC,00832-0465-15,NDC,,BOTH,1,GR,6.55,4.81,6.22,,,6.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,,,5.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.29,,,6.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.81,,,4.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.24,,,3.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.57,,,5.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.22,,,6.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.11,6.29,
MORPHINE SULFATE TAB ER 15 MG,Rx68084015701,CDM,,,250,RC,68084-0157-01,NDC,,BOTH,15,ME,6.56,5.73,6.23,,,6.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.12,,,5.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.25,,,3.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.04,,,6.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.58,,,5.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.23,,,6.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.9,,,5.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.21,,,3.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.12,6.3,
LACOSAMIDE TAB 200 MG,Rx60687069811,CDM,,,250,RC,60687-0698-11,NDC,,BOTH,200,ME,6.62,5.96,6.29,,,8.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.16,,,7.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,4.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.24,,,4.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,8.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.36,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.87,,,7.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.28,,,7.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.09,,,8.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.24,,,4.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.63,,,8.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,8.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.96,,,9.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.24,,,3.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,6.36,
BETAMETHASONE DIPROPIONATE AUGMENTED CREAM 0.05%,Rx51672131003,CDM,,,250,RC,51672-1310-03,NDC,,BOTH,1,EA,6.79,5.99,6.45,,,6.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.3,,,5.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.33,,,3.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.52,,,6.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.99,,,4.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.36,,,3.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.25,,,6.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.33,,,3.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.77,,,5.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.45,,,6.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.33,,,3.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.3,6.52,
HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,Rx00000005861,CDM,,,250,RC,00000-0058-61,NDC,,BOTH,15,ML,6.99,6.29,6.64,,,6.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.45,,,5.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,5.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,3.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,5.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.43,,,3.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,6.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.71,,,6.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.14,,,5.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.46,,,5.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.43,,,6.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.43,,,3.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.94,,,5.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.64,,,6.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,6.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.43,,,3.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,6.71,
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG,Rx68084069911,CDM,,,250,RC,68084-0699-11,NDC,,BOTH,1,EA,7,6.3,6.65,,,6.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,,,5.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.43,,,3.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.72,,,6.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.15,,,5.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.46,,,3.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.44,,,6.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.43,,,3.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.95,,,5.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.65,,,6.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.43,,,3.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.46,6.72,
SILVER SULFADIAZINE CREAM 1%,Rx61570013125,CDM,,,250,RC,61570-0131-25,NDC,,BOTH,1,EA,7.2,5.76,6.84,,,6.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.53,,,3.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.91,,,6.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.29,,,5.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.56,,,3.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.62,,,6.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.53,,,3.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.12,,,6.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.84,,,6.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.53,,,3.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,6.91,
BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV),Rx00054017713,CDM,,,250,RC,00054-0177-13,NDC,,BOTH,8,ME,7.33,6.55,6.96,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.72,,,5.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.6,,,6.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.6,,,3.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.6,,,6.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.59,,,3.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.6,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.04,,,7.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.63,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.74,,,6.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.59,,,3.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.23,,,6.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.6,,,6.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.59,,,3.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.72,7.04,
HC PED/CHILD ARMBOARD 2X6,Px00000446WNH,CDM,,,270,RC,,,,BOTH,,,7.35,6.62,6.98,,,6.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.73,,,5.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,6.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,3.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,6.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,3.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,6.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.06,,,7.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.4,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.64,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.76,,,6.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,3.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.25,,,6.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.98,,,6.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,6.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,3.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.73,7.06,
LATANOPROST OPHTH SOLN 0.005%,Rx61314054701,CDM,,,250,RC,61314-0547-01,NDC,,BOTH,1,EA,7.35,6.49,6.98,,,12.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.73,,,11.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,7.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,7.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,12.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.06,,,13.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.4,,,11.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.64,,,11.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.76,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,7.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.98,,,12.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,13.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.6,,,3.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.73,7.06,
TRIAMCINOLONE ACETONIDE CREAM 0.1%,Rx33342032980,CDM,,,250,RC,33342-0329-80,NDC,,BOTH,1,EA,7.41,6.67,7.04,,,7.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,,,5.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.67,,,6.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.67,,,6.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.67,,,6.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.63,,,3.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.67,,,6.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.11,,,7.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,,,5.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.67,,,3.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.63,,,3.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.04,,,7.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.67,,,6.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.63,,,3.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.78,7.11,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx71205010630,CDM,,,250,RC,71205-0106-30,NDC,,BOTH,1,GR,7.58,6.82,7.2,,,7.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.91,,,5.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.71,,,3.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.28,,,7.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.57,,,5.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3.75,,,3.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.71,,,3.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.44,,,6.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.2,,,7.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.82,,,6.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.71,,,3.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.91,7.28,
HC DRESSING DUO DERM 4X4 X-THIN,Px00000893WNH,CDM,,,270,RC,,,,BOTH,,,7.7,6.93,7.32,,,6.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.01,,,6.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,6.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,3.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,6.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.77,,,3.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,6.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.39,,,7.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,6.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.81,,,6.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.08,,,7.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.77,,,3.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.32,,,6.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.77,,,3.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.01,7.39,
HC COUNTER NEEDLE MAGNET FOAM DEROYAL SURGIMATE,Sx000025-0401,CDM,,,270,RC,,,,BOTH,,,7.73,6.36,7.34,,,6.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.03,,,5.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,5.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,3.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,5.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.79,,,3.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,6.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.42,,,6.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.68,,,5.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.83,,,5.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.11,,,6.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.79,,,3.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.57,,,6.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.34,,,6.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.96,,,6.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.79,,,3.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,7.42,
HC DRESSING DUO DERM X-THIN 4X4 XTHIN CTRL GEL FORMULA,Sx00000187955,CDM,,,270,RC,,,,BOTH,,,8.07,7.26,7.67,,,7.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.29,,,6.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,6.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,4.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,6.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.95,,,4.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,7.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.93,,,6.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3.99,,,6.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.42,,,7.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.95,,,4.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.67,,,7.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,7.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3.95,,,3.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.29,7.75,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx68382037001,CDM,,,250,RC,68382-0370-01,NDC,,BOTH,1,GR,8.15,7.34,7.74,,,7.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.36,,,6.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.34,,,7.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.34,,,7.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.34,,,7.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.99,,,3.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.34,,,7.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.99,,,5.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.03,,,4.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.5,,,7.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.99,,,3.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.93,,,6.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.34,,,7.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3.99,,,3.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.36,7.82,
FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT,Rx00054327099,CDM,,,250,RC,00054-3270-99,NDC,,BOTH,0.05,ME,8.2,7.38,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.06,,,4.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
MICONAZOLE NITRATE CREAM 2%,Rx00472073514,CDM,,,250,RC,00472-0735-14,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.06,,,4.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT),Rx00487590199,CDM,,,250,RC,00487-5901-99,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.06,,,4.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
PHENOL LIQUID 1.4%,Rx00904630521,CDM,,,250,RC,00904-6305-21,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.06,,,4.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
ALUMINUM SULFATE & CALCIUM ACETATE POWD PACK,Rx51224016299,CDM,,,250,RC,51224-0162-99,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.03,,,6.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.06,,,4.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT),Rx00487278401,CDM,,,250,RC,00487-2784-01,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,6.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,4.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,6.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.03,,,6.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.06,,,6.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
BACITRACIN-POLYMYXIN B OINT,Rx12547023813,CDM,,,250,RC,12547-0238-13,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.4,,,6.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,6.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,4.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,6.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.03,,,6.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.06,,,6.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.97,,,6.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
WITCH HAZEL-GLYCERIN CLEANSING PADS,Rx50289325001,CDM,,,250,RC,50289-3250-01,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,12.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.4,,,10.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,11.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,6.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,11.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,6.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,12.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,13.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.03,,,10.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.06,,,10.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,12.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,6.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.97,,,11.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,12.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,12.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
SALINE NASAL SPRAY 0.65%,Rx00904386575,CDM,,,250,RC,00904-3865-75,NDC,,BOTH,1,EA,8.2,7.38,7.79,,,12.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.4,,,10.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,11.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,11.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,7.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,12.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.03,,,10.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.06,,,10.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,12.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,7.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.97,,,11.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,12.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,13.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.02,,,4.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.4,7.87,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx68308015215,CDM,,,250,RC,68308-0152-15,NDC,,BOTH,1,GR,8.26,7.43,7.85,,,7.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.44,,,6.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.43,,,7.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.43,,,7.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.43,,,7.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.05,,,4.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.43,,,7.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.93,,,7.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.07,,,6.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.09,,,4.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,,,7.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.05,,,4.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.02,,,7.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.85,,,7.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.43,,,7.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.05,,,4.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.44,7.93,
MICONAZOLE NITRATE CREAM 2%,Rx61269073514,CDM,,,250,RC,61269-0735-14,NDC,,BOTH,1,EA,8.31,7.38,7.89,,,7.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,,,6.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.98,,,7.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.11,,,6.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.11,,,4.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.65,,,7.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.06,,,7.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.07,,,4.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.48,7.98,
HC DRESSING TEGADERM 6X8 TRANSPARENT STERILE,Sx00000001628,CDM,,,270,RC,,,,BOTH,,,8.32,7.64,7.9,,,7.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.49,,,6.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.49,,,7.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.49,,,4.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.49,,,7.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.49,,,7.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.12,,,6.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.12,,,6.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.65,,,7.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.07,,,7.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.49,,,8.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.49,7.99,
HC DRESSING TEGADERM,Px00009259WNH,CDM,,,270,RC,,,,BOTH,,,8.33,7.5,7.91,,,7.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.5,,,6.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,6.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,4.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,6.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,7.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8,,,8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.12,,,6.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.12,,,6.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.66,,,7.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.08,,,7.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,7.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.08,,,4.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.5,8,
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,Rx00168035705,CDM,,,250,RC,00168-0357-05,NDC,,BOTH,1,EA,8.4,7.56,7.98,,,7.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.56,,,7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.56,,,4.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.56,,,7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.12,,,4.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.56,,,7.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.06,,,8.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.17,,,6.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.16,,,6.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,7.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.12,,,4.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.14,,,7.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.98,,,7.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.56,,,7.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.12,,,4.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.55,8.06,
TERBUTALINE SULFATE TAB 2.5 MG,Rx00527131801,CDM,,,250,RC,00527-1318-01,NDC,,BOTH,2.5,ME,8.45,7.61,8.03,,,7.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.59,,,6.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,7.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,4.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,7.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.14,,,4.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,7.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.11,,,8.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.21,,,6.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.18,,,6.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,7.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.14,,,4.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.18,,,7.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,7.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,8.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.14,,,4.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.59,8.11,
CLOTRIMAZOLE CREAM 1%,Rx00904782231,CDM,,,250,RC,00904-7822-31,NDC,,BOTH,1,EA,8.57,7.71,8.14,,,8.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.68,,,6.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.2,,,4.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.23,,,8.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.3,,,6.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.24,,,4.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.2,,,4.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.28,,,7.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.14,,,8.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.2,,,4.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.68,8.23,
HC STOCKING TED LG LONG KNEE HIGH PR PR,Sx00000007594,CDM,,,270,RC,,,,BOTH,,,8.68,7.81,8.25,,,7.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.77,,,6.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,7.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,4.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,7.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,7.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.33,,,8.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.38,,,6.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,6.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.38,,,7.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.25,,,7.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,8.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.25,,,4.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.77,8.33,
SILVER SULFADIAZINE CREAM 1%,Rx43598021025,CDM,,,250,RC,43598-0210-25,NDC,,BOTH,1,EA,8.76,6.6,8.32,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.83,,,5.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,6.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,3.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,6.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.29,,,3.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,7.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.44,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.34,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.06,,,6.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.29,,,3.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.45,,,6.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.32,,,6.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,6.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.29,,,4.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.83,8.41,
HC STOCKING ANTI EMBOLISM TED HOSE S REG KNEE HIGH,Sx00000007071,CDM,,,270,RC,,,,BOTH,,,8.78,7.9,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.85,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.45,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.46,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.85,8.43,
HC STOCKING TED HOSE LG REG KNEE HIGH,Sx0000007203-,CDM,,,270,RC,,,,BOTH,,,8.78,7.9,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.85,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.45,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.46,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.85,8.43,
HC STOCKING TED HOSE XL REG KNEE HIGH,Sx00000007604,CDM,,,270,RC,,,,BOTH,,,8.78,7.9,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.85,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.45,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.46,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.85,8.43,
HC STOCKING TED HOSE M LONG KNEE HIGH,Sx0000007480-,CDM,,,270,RC,,,,BOTH,,,8.78,7.9,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.85,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.45,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.46,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.85,8.43,
HC STOCKING TED HOSE XL LONG KNEE HIGH,Sx00000007802,CDM,,,270,RC,,,,BOTH,,,8.78,7.9,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.85,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.45,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.46,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.3,,,4.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.85,8.43,
HC STOCKING TED HOSE MED KNEE HIGH REG,Sx0000007115-,CDM,,,270,RC,,,,BOTH,,,8.79,7.91,8.35,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,6.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,4.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,7.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.31,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.44,,,8.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.46,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,6.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.09,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.31,,,4.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.47,,,7.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.35,,,7.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.31,,,4.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.86,8.44,
FENTANYL TD PATCH 72HR 25 MCG/HR,Rx60505700600,CDM,,,250,RC,60505-7006-00,NDC,,BOTH,0.05,ME,8.86,7.97,8.42,,,8.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.91,,,6.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.51,,,8.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.51,,,6.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.38,,,4.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.15,,,8.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.53,,,7.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.34,,,4.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.91,8.51,
BUDESONIDE INHALATION SUSP 0.25 MG/2ML,Rx69097031886,CDM,J7626,HCPCS,636,RC,69097031886,NDC,,BOTH,2,ML,8.88,7.99,8.44,,,8.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.93,,,6.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.52,,,8.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.53,,,6.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.17,,,8.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.55,,,7.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.44,,,8.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.93,8.52,
ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,Rx00121050405,CDM,,,250,RC,00121-0504-05,NDC,,BOTH,5,ML,8.88,7.99,8.44,,,8.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,6.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,7.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,4.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,7.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,4.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.52,,,8.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.53,,,6.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.39,,,6.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.17,,,8.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,4.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.55,,,7.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.44,,,8.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.35,,,4.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.93,8.52,
MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT),Rx00054356699,CDM,,,250,RC,00054-3566-99,NDC,,BOTH,1,ML,8.9,7.93,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.94,,,6.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.36,,,4.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.54,,,8.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.54,,,6.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.19,,,8.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.36,,,4.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.57,,,7.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.36,,,4.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.94,8.54,
NYSTATIN CREAM 100000 UNIT/GM,Rx45802005911,CDM,,,250,RC,45802-0059-11,NDC,,BOTH,1,GR,8.91,6.75,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.95,,,6.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.55,,,8.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.55,,,6.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,,,4.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.2,,,8.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.57,,,7.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.95,8.55,
TOBRAMYCIN OPHTH SOLN 0.3%,Rx62332051805,CDM,,,250,RC,62332-0518-05,NDC,,BOTH,1,EA,8.91,7.79,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.95,,,6.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.55,,,8.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.55,,,6.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.41,,,4.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.2,,,8.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.57,,,7.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.02,,,8.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.37,,,4.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.95,8.55,
SILVER SULFADIAZINE CREAM 1%,Rx67877012485,CDM,,,250,RC,67877-0124-85,NDC,,BOTH,1,EA,8.95,6.89,8.5,,,8.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.98,,,6.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.06,,,8.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.06,,,8.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.06,,,8.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.06,,,8.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.59,,,8.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.58,,,6.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.43,,,4.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.23,,,8.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.61,,,7.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,,,8.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.06,,,8.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.39,,,4.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.98,8.59,
LIDOCAINE HCL VISCOUS SOLN 2%,Rx62135071242,CDM,,,250,RC,62135-0712-42,NDC,,BOTH,0.025,ME,8.98,8.09,8.53,,,8.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7,,,7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.62,,,8.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.6,,,6.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.44,,,4.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.63,,,7.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.53,,,8.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.4,,,4.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7,8.62,
HC SPONGE DENTAL ROLL,Px00004508WNH,CDM,,,270,RC,,,,BOTH,,,9.03,8.13,8.58,,,8.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.04,,,7.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.13,,,7.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.13,,,4.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.13,,,7.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.42,,,4.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.13,,,8.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.67,,,8.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.64,,,7.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.47,,,7.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.42,,,4.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.68,,,7.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.58,,,8.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.13,,,8.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.42,,,4.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.04,8.67,
TICAGRELOR TAB 90 MG,Rx00186077760,CDM,,,250,RC,00186-0777-60,NDC,,BOTH,90,ME,9.1,8.02,8.65,,,11.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.1,,,9.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,10.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,6.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,10.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.46,,,6.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,11.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.74,,,12.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.69,,,9.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,9.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.37,,,11.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.46,,,6.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.65,,,11.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,11.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.46,,,4.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.1,8.74,
MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT),Rx00000002614,CDM,,,250,RC,00000-0026-14,NDC,,BOTH,1,ML,9.16,8.24,8.7,,,8.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.14,,,7.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,7.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,4.605,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,7.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.605,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.79,,,8.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.73,,,7.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.53,,,7.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.43,,,8.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,7.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,8.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.49,,,4.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.14,8.79,
ARIPIPRAZOLE TAB 5 MG,Rx50268008811,CDM,,,250,RC,50268-0088-11,NDC,,BOTH,5,ME,9.18,8.26,8.72,,,8.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.16,,,7.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.5,,,4.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.81,,,8.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.75,,,6.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.54,,,4.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.45,,,8.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.5,,,4.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.72,,,8.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,,,8.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.5,,,4.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.16,8.81,
HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML,Rx00000003358,CDM,,,250,RC,00000-0033-58,NDC,,BOTH,5,ML,9.18,8.26,8.72,,,8.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.16,,,7.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,7.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,4.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,7.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,8.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.81,,,8.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.75,,,7.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.54,,,7.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.45,,,8.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,7.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,8.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,8.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.5,,,4.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.16,8.81,
POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,Rx54288012501,CDM,,,250,RC,54288-0125-01,NDC,,BOTH,1,EA,9.2,8.28,8.74,,,8.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.18,,,7.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.51,,,4.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.83,,,8.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.76,,,6.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.55,,,4.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,,,8.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.51,,,4.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.74,,,8.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.51,,,4.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.18,8.83,
FLUOCINONIDE OINT 0.05%,Rx51672126401,CDM,,,250,RC,51672-1264-01,NDC,,BOTH,1,EA,9.2,8.21,8.74,,,8.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.18,,,7.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,7.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,4.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,7.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.51,,,4.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,8.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.83,,,8.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.76,,,7.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.55,,,7.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.46,,,8.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.51,,,4.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.82,,,7.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.74,,,8.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,8.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.51,,,4.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.18,8.83,
HC ESOPHAGEAL STETHOSCOPE 18FR 400 SERIES W/TEMP SENSOR,Sx000ES400-18,CDM,,,270,RC,,,,BOTH,,,9.27,8.34,8.81,,,8.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.23,,,7.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,4.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,7.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.54,,,4.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.9,,,8.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.81,,,7.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.59,,,7.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.53,,,8.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.54,,,4.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,7.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.81,,,8.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.34,,,8.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.54,,,4.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.23,8.9,
TRIAMCINOLONE ACETONIDE CREAM 0.1%,Rx45802006436,CDM,,,250,RC,45802-0064-36,NDC,,BOTH,1,EA,9.34,8.41,8.87,,,8.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.29,,,7.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,7.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,4.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,7.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.58,,,4.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,8.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.97,,,8.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,7.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.62,,,7.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.59,,,8.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.58,,,4.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.94,,,7.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.87,,,8.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,8.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.58,,,4.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.29,8.97,
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,Rx62332058204,CDM,,,250,RC,62332-0582-04,NDC,,BOTH,1,EA,9.61,8.66,9.13,,,9.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.5,,,7.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.65,,,8.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.65,,,8.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.65,,,8.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.71,,,4.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.65,,,8.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.23,,,9.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.06,,,7.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.76,,,4.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.84,,,8.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.71,,,4.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.17,,,8.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.13,,,9.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.65,,,8.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.71,,,4.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.5,9.23,
HYDROCORTISONE CREAM 1%,Rx00472034356,CDM,,,250,RC,00472-0343-56,NDC,,BOTH,1,EA,9.67,8.7,9.19,,,9.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.74,,,4.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.28,,,9.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.11,,,7.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.79,,,4.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.9,,,8.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.74,,,4.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.22,,,8.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.19,,,9.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.74,,,4.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,9.28,
LIDOCAINE PATCH 5%,Rx00378905516,CDM,,,250,RC,00378-9055-16,NDC,,BOTH,1,EA,9.67,8.7,9.19,,,8.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,7.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,8.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,4.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,8.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.74,,,4.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,8.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.28,,,9.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.11,,,7.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.79,,,7.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.9,,,8.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.74,,,4.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.22,,,8.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.19,,,8.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,9.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.74,,,4.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,9.28,
OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),Rx68180067801,CDM,,,250,RC,68180-0678-01,NDC,,BOTH,1,ML,9.73,8.69,9.24,,,9.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.59,,,7.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,,,8.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,,,8.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,,,8.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,,,8.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.34,,,9.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.15,,,7.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.95,,,8.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.27,,,8.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.24,,,9.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,,,8.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.59,9.34,
AZITHROMYCIN FOR SUSP 200 MG/5ML,Rx00093202631,CDM,,,250,RC,00093-2026-31,NDC,,BOTH,5,ML,9.74,8.78,9.25,,,9.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,,,7.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.77,,,8.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.77,,,8.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.77,,,8.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.77,,,8.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.35,,,9.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.16,,,7.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.96,,,8.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.28,,,8.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.25,,,9.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.77,,,8.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.77,,,4.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,9.35,
SORBITOL SOLUTION (BULK),Rx46287050030,CDM,,,250,RC,46287-0500-30,NDC,,BOTH,1,EA,9.8,8.09,9.31,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.64,,,7.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.41,,,9.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.2,,,7.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.85,,,7.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.02,,,9.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.33,,,8.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.8,,,4.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.64,9.41,
HC SPONGE LAP 4PLY 400 X-RAY DETECTABLE PRE WASHED,Sx00000000400,CDM,,,270,RC,,,,BOTH,,,9.82,11.15,9.33,,,8.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.66,,,7.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.84,,,8.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.84,,,5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.84,,,8.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.84,,,8.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.43,,,9.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.22,,,7.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.86,,,7.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.03,,,9.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.35,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,8.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.84,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.81,,,4.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.66,9.43,
DRONABINOL CAP 2.5 MG,Rx00904674561,CDM,,,250,RC,00904-6745-61,NDC,,BOTH,2.5,ME,9.84,8.86,9.35,,,9.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.68,,,7.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.86,,,8.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.86,,,8.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.86,,,8.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.86,,,8.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.45,,,9.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.23,,,7.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.87,,,4.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.05,,,9.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.36,,,8.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.35,,,9.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.86,,,8.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.82,,,4.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.68,9.45,
TROPICAMIDE OPHTH SOLN 1%,Rx70069012101,CDM,,,250,RC,70069-0121-01,NDC,,BOTH,1,EA,9.86,7.87,9.37,,,9.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.87,,,8.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.87,,,8.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.87,,,8.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.83,,,4.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.87,,,8.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.47,,,9.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.25,,,7.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.88,,,4.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.07,,,9.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.83,,,4.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.38,,,8.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.37,,,9.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.87,,,8.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.83,,,4.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,9.47,
ZINC OXIDE OINT 20%,Rx00536131628,CDM,,,250,RC,00536-1316-28,NDC,,BOTH,1,EA,9.88,8.89,9.39,,,9.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.26,,,7.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.09,,,9.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.4,,,8.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.39,,,9.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,9.48,
ZINC OXIDE OINT 20%,Rx00536570028,CDM,,,250,RC,00536-5700-28,NDC,,BOTH,1,EA,9.88,8.89,9.39,,,9.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.26,,,7.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.09,,,9.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.4,,,8.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.39,,,9.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.84,,,4.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,9.48,
TROPICAMIDE OPHTH SOLN 1%,Rx17478010212,CDM,,,250,RC,17478-0102-12,NDC,,BOTH,1,EA,9.9,8.91,9.41,,,9.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.91,,,8.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.91,,,8.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.91,,,8.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.85,,,4.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.91,,,8.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.5,,,9.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.28,,,7.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.9,,,4.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.11,,,9.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.85,,,4.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.41,,,9.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.91,,,8.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.85,,,4.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,9.5,
RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ),Rx51991036299,CDM,,,250,RC,51991-0362-99,NDC,,BOTH,5,ME,9.91,8.92,9.41,,,9.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,,,7.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,,,4.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.51,,,9.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.28,,,7.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.9,,,4.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.12,,,9.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,,,4.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.41,,,9.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.86,,,4.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,9.51,
CLOTRIMAZOLE CREAM 1%,Rx00536127222,CDM,,,250,RC,00536-1272-22,NDC,,BOTH,1,EA,9.97,8.97,9.47,,,9.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.97,,,8.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.97,,,8.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.97,,,8.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.97,,,8.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.57,,,9.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.33,,,7.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.93,,,4.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.17,,,9.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.47,,,8.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.47,,,9.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.97,,,8.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.89,,,4.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,9.57,
HC SPLINT FINGER FROG,Px00032800WNH,CDM,,,270,RC,,,,BOTH,,,10,9,9.5,,,9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,7.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9,,,8.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9,,,5.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9,,,8.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.9,,,5.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9,,,9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.6,,,9.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.35,,,7.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.95,,,7.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,9.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.9,,,5.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.5,,,8.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.5,,,9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9,,,9.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.9,,,4.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,9.6,
ERYTHROMYCIN TAB 250 MG,Rx75834024230,CDM,,,250,RC,75834-0242-30,NDC,,BOTH,250,ME,10.09,9.08,9.59,,,9.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.08,,,9.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.08,,,9.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.08,,,9.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.94,,,4.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.08,,,9.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.69,,,9.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.42,,,7.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4.99,,,4.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.28,,,9.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.94,,,4.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.58,,,8.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.59,,,9.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.08,,,9.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4.94,,,4.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,9.69,
OXYCODONE HCL TAB ER 12HR DETER 40 MG,Rx59011044020,CDM,,,250,RC,59011-0440-20,NDC,,BOTH,40,ME,10.09,8.75,9.59,,,20.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,17.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.08,,,18.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.08,,,11.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.08,,,18.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.94,,,11.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.08,,,20.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.69,,,21.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.42,,,17.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4.99,,,17.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.28,,,20.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.94,,,11.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.58,,,18.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.59,,,20.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.08,,,21.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4.94,,,4.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,9.69,
BETAMETHASONE DIPROPIONATE AUGMENTED CREAM 0.05%,Rx45802037632,CDM,,,250,RC,45802-0376-32,NDC,,BOTH,1,EA,10.22,9.2,9.71,,,9.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.97,,,7.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,8.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,5.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,8.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.01,,,5.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,9.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.81,,,9.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.51,,,7.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.06,,,7.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.4,,,9.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.01,,,5.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.69,,,8.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.71,,,9.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.2,,,9.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.01,,,5.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,9.81,
"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",Rx76329301505,CDM,,,250,RC,76329-3015-05,NDC,,BOTH,1,EA,10.26,8.41,9.75,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8,,,9.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,9.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,6.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,9.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,6.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,11.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,9.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,9.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.44,,,10.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,6.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,10.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.75,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,11.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,5.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8,9.85,
"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",Rx76329301505,CDM,,,250,RC,76329-3015-05,NDC,,BOTH,1,EA,10.26,20.75,9.75,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8,,,9.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,9.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,6.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,9.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,6.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,11.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.54,,,9.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,9.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.44,,,10.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,6.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,10.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.75,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,11.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.03,,,5.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8,9.85,
PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ),Rx00000000681,CDM,,,250,RC,00000-0006-81,NDC,,BOTH,1,ML,10.36,9.32,9.84,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,8.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,5.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,8.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.95,,,9.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.61,,,8.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,8.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,9.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.81,,,8.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.84,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,9.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,9.95,
HC BULB CONTROL IRR (ASEPTO) STERILE,Sx00000067000,CDM,,,270,RC,,,,BOTH,,,10.37,4.5,9.85,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.09,,,8.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,8.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,5.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,8.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.96,,,9.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.62,,,8.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.13,,,8.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,9.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.81,,,8.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,9.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,9.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.08,,,5.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.09,9.96,
SIMETHICONE SUSP 40 MG/0.6ML,Rx19903001021,CDM,,,250,RC,19903-0010-21,NDC,,BOTH,0.6,ML,10.53,9.48,10,,,10,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.21,,,8.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.11,,,10.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.21,,,5.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.69,,,9.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.95,,,8.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10,,,10,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.48,,,9.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.16,,,5.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.21,10.11,
OXYCODONE HCL SOLN 5 MG/5ML,Rx00121482705,CDM,,,250,RC,00121-4827-05,NDC,,BOTH,5,ML,10.54,9.49,10.01,,,9.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.22,,,8.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.49,,,8.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.49,,,5.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.49,,,8.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.16,,,5.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.49,,,9.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.12,,,10.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.22,,,8.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.7,,,9.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.16,,,5.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.96,,,8.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.01,,,9.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.49,,,10.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.16,,,5.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.22,10.12,
FAMCICLOVIR TAB 500 MG,Rx00078036815,CDM,,,250,RC,00078-0368-15,NDC,,BOTH,500,ME,10.58,9.52,10.05,,,10.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,,,8.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.52,,,9.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.52,,,9.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.52,,,9.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.52,,,9.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.16,,,10.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.24,,,5.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.73,,,9.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.99,,,8.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.05,,,10.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.52,,,9.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.18,,,5.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,10.16,
MESALAMINE CAP ER 250 MG,Rx54092018981,CDM,,,250,RC,54092-0189-81,NDC,,BOTH,250,ME,10.59,9.54,10.06,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,8.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.78,,,8.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.24,,,8.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.74,,,9.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9,,,9.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.06,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,10.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,10.17,
MESALAMINE CAP ER 500 MG,Rx54092019112,CDM,,,250,RC,54092-0191-12,NDC,,BOTH,500,ME,10.59,9.54,10.06,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.26,,,8.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,5.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.78,,,8.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.24,,,8.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.74,,,9.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9,,,9.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.06,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.53,,,10.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.26,10.17,
OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV),Rx00004080085,CDM,,,250,RC,00004-0800-85,NDC,,BOTH,75,ME,10.6,9.54,10.07,,,17.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.27,,,15.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,16.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,10.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,16.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,10.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,17.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,19.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,15.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.25,,,15.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.75,,,18.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,10.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.01,,,16.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.07,,,17.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.54,,,18.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.19,,,5.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.27,10.18,
HC CATH IV 20G ANGIO 1.88,Px00008469WNH,CDM,,,270,RC,,,,BOTH,,,10.64,9.58,10.11,,,9.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.3,,,8.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.58,,,8.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.58,,,5.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.58,,,8.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.58,,,9.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.82,,,8.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.27,,,8.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.79,,,9.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.04,,,9.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,9.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.58,,,10.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.21,,,5.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.3,10.21,
MICONAZOLE NITRATE CREAM 2%,Rx61269073556,CDM,,,250,RC,61269-0735-56,NDC,,BOTH,1,EA,10.73,9.66,10.19,,,10.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.37,,,8.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.3,,,10.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.31,,,5.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.87,,,9.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.12,,,9.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.19,,,10.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.26,,,5.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.37,10.3,
LUBIPROSTONE CAP 8 MCG,Rx64764008060,CDM,,,250,RC,64764-0080-60,NDC,,BOTH,0.008,ME,10.76,9.68,10.22,,,10.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.39,,,8.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.68,,,9.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.68,,,9.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.68,,,9.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.68,,,9.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.33,,,10.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.33,,,5.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.9,,,9.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.15,,,9.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.22,,,10.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.68,,,9.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.27,,,5.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.39,10.33,
ERYTHROMYCIN OPHTH OINT 5 MG/GM,Rx00574402411,CDM,,,250,RC,00574-4024-11,NDC,,BOTH,1,GR,10.8,9.72,10.26,,,10.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.29,,,5.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.37,,,10.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.94,,,7.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.94,,,9.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.29,,,5.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.18,,,9.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.26,,,10.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.29,,,5.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,10.37,
OXYCODONE HCL TAB ER 12HR DETER 20 MG,Rx59011042020,CDM,,,250,RC,59011-0420-20,NDC,,BOTH,20,ME,10.85,9.38,10.31,,,13.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.46,,,11.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,12.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,7.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,12.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,7.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,13.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.42,,,14.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.97,,,11.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.37,,,11.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.98,,,14.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,7.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.22,,,13.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.31,,,13.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,14.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,5.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,10.42,
MUPIROCIN OINT 2%,Rx68462018022,CDM,,,250,RC,68462-0180-22,NDC,,BOTH,1,EA,10.86,9.77,10.32,,,9.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.47,,,8.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,9.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,5.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,9.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,5.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,9.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.43,,,10.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.98,,,8.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.37,,,8.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.99,,,10,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,5.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.23,,,9.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.32,,,9.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,10.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.32,,,5.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.47,10.43,
SUCRALFATE SUSP 1 GM/10ML,Rx60687073842,CDM,,,250,RC,60687-0738-42,NDC,,BOTH,10,ML,10.9,9.81,10.36,,,10.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,,,8.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.81,,,9.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.81,,,9.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.81,,,9.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.81,,,9.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.03,,,10.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.27,,,9.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.36,,,10.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.81,,,9.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.34,,,5.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,10.46,
HC CATH IV ANGIO 20X1.88 AUTOGUARD,Sx00000381437,CDM,,,270,RC,,,,BOTH,,,10.97,9.87,10.42,,,9.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.56,,,8.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,9.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,5.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,9.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,9.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.53,,,10.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.06,,,8.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.43,,,8.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.09,,,10.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.32,,,9.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.42,,,9.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,10.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.56,10.53,
HC SOL IV DEX 5 PCT 1000ML,Sx00002B0064X,CDM,,,270,RC,,,,BOTH,,,10.98,11.73,10.43,,,11.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.56,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.88,,,10.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.88,,,6.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.88,,,10.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,6.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.88,,,11.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.54,,,12.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.07,,,10.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.43,,,10.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.1,,,12.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,6.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.33,,,11.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.43,,,11.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.88,,,12.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.38,,,5.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.56,10.54,
HC DRESSING DUO DERM 4X4,Px00000879WNH,CDM,,,270,RC,,,,BOTH,,,10.99,9.89,10.44,,,9.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.57,,,8.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.89,,,9.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.89,,,5.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.89,,,9.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.89,,,9.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.55,,,10.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.44,,,8.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,10.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.34,,,9.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.44,,,9.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.89,,,10.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.39,,,5.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.57,10.55,
OXYMETAZOLINE HCL NASAL SOLN 0.05%,Rx00904676130,CDM,,,250,RC,00904-6761-30,NDC,,BOTH,1,EA,11.01,9.91,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.59,,,8.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.91,,,9.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.91,,,9.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.91,,,9.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.91,,,9.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.57,,,10.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.09,,,8.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.45,,,5.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.13,,,10.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.36,,,9.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.91,,,9.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.39,,,5.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.59,10.57,
FENTANYL TD PATCH 72HR 50 MCG/HR,Rx60505708200,CDM,,,250,RC,60505-7082-00,NDC,,BOTH,0.075,ME,11.04,9.94,10.49,,,9.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.61,,,8.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.94,,,9.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.94,,,5.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.94,,,9.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.41,,,5.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.94,,,9.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.6,,,10.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.11,,,8.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.46,,,8.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.16,,,10.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.41,,,5.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.38,,,9.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.49,,,9.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.94,,,10.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.41,,,5.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.61,10.6,
OXYCODONE HCL TAB ER 12HR DETER 10 MG,Rx59011041020,CDM,,,250,RC,59011-0410-20,NDC,,BOTH,10,ME,11.23,9.69,10.67,,,10.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.76,,,8.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,9.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,5.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,9.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,10.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,10.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.25,,,8.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.56,,,8.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.33,,,10.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.55,,,9.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.67,,,10.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,10.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.5,,,5.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.76,10.78,
"HC DRESSING FOAM TEGADERM SILICONE 2"" x 2""",Sx00000090643,CDM,,,270,RC,,,,BOTH,,,11.3,15.79,10.74,,,10.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.81,,,8.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,9.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,5.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,9.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,10.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.85,,,10.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.59,,,8.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,10.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.61,,,9.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.74,,,10.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.17,,,10.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.81,10.85,
DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ),Rx00597035561,CDM,,,250,RC,00597-0355-61,NDC,,BOTH,75,ME,11.31,10.18,10.74,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,9.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,5.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,9.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,10.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.6,,,8.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.41,,,10.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.61,,,9.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.74,,,10.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.18,,,10.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.54,,,5.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.82,10.86,
HYDROCORTISONE CREAM 1%,Rx45802043803,CDM,,,250,RC,45802-0438-03,NDC,,BOTH,1,EA,11.34,10.21,10.77,,,10.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.85,,,8.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.56,,,5.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.89,,,10.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.33,,,8.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.61,,,5.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.43,,,10.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.56,,,5.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.64,,,9.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.77,,,10.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.21,,,10.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.56,,,5.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.85,10.89,
CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,Rx00378087116,CDM,,,250,RC,00378-0871-16,NDC,,BOTH,0.1,ME,11.41,10.27,10.84,,,10.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.9,,,8.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,9.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,5.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,9.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.59,,,5.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,10.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.95,,,10.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.39,,,8.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.65,,,8.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.5,,,10.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.59,,,5.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.7,,,9.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.84,,,10.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,10.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.59,,,5.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.9,10.95,
COLCHICINE TAB 0.6 MG,Rx60687038911,CDM,,,250,RC,60687-0389-11,NDC,,BOTH,0.6,ME,11.43,10.29,10.86,,,10.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,,,8.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.29,,,10.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.29,,,10.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.29,,,10.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.6,,,5.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.29,,,10.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.97,,,10.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.4,,,8.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.66,,,5.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.52,,,10.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.6,,,5.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.86,,,10.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.29,,,10.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.6,,,5.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.92,10.97,
PHENOL LIQUID 1.4%,Rx46122027830,CDM,,,250,RC,46122-0278-30,NDC,,BOTH,1,EA,11.46,10.31,10.89,,,10.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.94,,,8.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.31,,,10.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.31,,,10.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.31,,,10.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.31,,,10.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11,,,11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.67,,,5.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.54,,,10.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.74,,,9.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.89,,,10.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.31,,,10.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.62,,,5.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.94,11,
HC DRESSING DUO DERM CGF 4X4 REG CTRL GEL FORMULA,Sx00000187660,CDM,,,270,RC,,,,BOTH,,,11.55,10.4,10.97,,,10.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.01,,,9.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,9.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,5.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,9.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,5.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,10.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.09,,,11.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,9.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.72,,,9.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.63,,,10.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,5.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.82,,,9.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.97,,,10.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,10.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.66,,,5.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.01,11.09,
CLOBETASOL PROPIONATE CREAM 0.05%,Rx21922001605,CDM,,,250,RC,21922-0016-05,NDC,,BOTH,1,EA,11.62,8.06,11.04,,,11.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.06,,,9.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.16,,,11.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.54,,,8.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.75,,,5.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.69,,,10.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.88,,,9.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.04,,,11.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.06,11.16,
OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),Rx27241013909,CDM,,,250,RC,27241-0139-09,NDC,,BOTH,1,ML,11.62,10.46,11.04,,,11.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.06,,,9.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.16,,,11.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.54,,,8.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.75,,,5.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.69,,,10.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.88,,,9.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.04,,,11.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,,,10.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.69,,,5.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.06,11.16,
"ESTROGENS, CONJUGATED TAB 0.625 MG",Rx00046110281,CDM,,,250,RC,00046-1102-81,NDC,,BOTH,0.625,ME,11.74,10.32,11.15,,,10.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.16,,,9.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.57,,,9.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.57,,,5.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.57,,,9.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.75,,,5.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.57,,,10.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.27,,,11.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.63,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.81,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.8,,,10.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.75,,,5.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.98,,,9.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.15,,,10.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.57,,,11.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.75,,,5.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.16,11.27,
PREGABALIN CAP 50 MG,Rx00071101341,CDM,,,250,RC,00071-1013-41,NDC,,BOTH,50,ME,12.07,11.03,11.47,,,16.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.41,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,15.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,9.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,15.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.91,,,9.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,16.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.59,,,17.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.87,,,14.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5.97,,,14.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.1,,,17.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.91,,,9.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.26,,,15.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.47,,,16.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,17.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5.91,,,5.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.41,11.59,
SALINE NASAL SPRAY 0.65%,Rx87701055205,CDM,,,250,RC,87701-0552-05,NDC,,BOTH,1,EA,12.09,10.88,11.49,,,11.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.43,,,9.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.88,,,10.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.88,,,10.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.88,,,10.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.92,,,5.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.88,,,10.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.61,,,11.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.89,,,8.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5.98,,,5.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.12,,,11.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.92,,,5.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.28,,,10.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.49,,,11.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.88,,,10.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5.92,,,5.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.43,11.61,
ERYTHROMYCIN OPHTH OINT 5 MG/GM,Rx24208091019,CDM,,,250,RC,24208-0910-19,NDC,,BOTH,1,GR,12.24,10.9,11.63,,,11.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.55,,,9.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.02,,,10.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.02,,,6.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.02,,,10.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6,,,6.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.02,,,11.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.75,,,11.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9,,,9.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.06,,,9.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.26,,,11.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6,,,6.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.4,,,10.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,11.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.02,,,11.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6,,,6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.55,11.75,
HC MAXI VESSEL LOOPS RED,Sx000DYNJVL02,CDM,,,270,RC,,,,BOTH,,,12.29,11.06,11.68,,,11.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.59,,,9.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,10.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,6.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,10.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.02,,,6.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,11.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.8,,,11.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.03,,,9.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.08,,,9.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.31,,,11.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.02,,,6.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.45,,,10.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.68,,,11.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,11.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.02,,,6.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.59,11.8,
MODAFINIL TAB 200 MG,Rx68084072111,CDM,,,250,RC,68084-0721-11,NDC,,BOTH,200,ME,12.65,11.39,12.02,,,17.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.87,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.39,,,16.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.39,,,10.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.39,,,16.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.2,,,10.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.39,,,17.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.14,,,18.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.3,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.26,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.64,,,18.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.2,,,10.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.75,,,16.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,17.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.39,,,18.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.2,,,6.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.87,12.14,
SUCRALFATE SUSP 1 GM/10ML,Rx00121097410,CDM,,,250,RC,00121-0974-10,NDC,,BOTH,10,ML,12.66,11.39,12.03,,,12.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.87,,,9.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.39,,,11.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.39,,,11.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.39,,,11.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.2,,,6.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.39,,,11.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.15,,,12.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.31,,,9.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.27,,,6.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.65,,,11.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.2,,,6.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.76,,,10.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.03,,,12.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.39,,,11.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.2,,,6.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.87,12.15,
LEVONORGESTREL TAB 1.5 MG,Rx00536114263,CDM,,,250,RC,00536-1142-63,NDC,,BOTH,1.5,ME,12.76,11.48,12.12,,,11.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.95,,,9.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.48,,,10.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.48,,,6.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.48,,,10.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.25,,,6.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.48,,,11.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.38,,,9.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.31,,,9.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.74,,,11.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.25,,,6.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.85,,,10.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.12,,,11.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.48,,,12.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.25,,,6.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.95,12.25,
TIMOLOL MALEATE OPHTH SOLN 0.5%,Rx68682081305,CDM,,,250,RC,68682-0813-05,NDC,,BOTH,1,EA,12.99,11.69,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.13,,,10.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.37,,,6.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.47,,,12.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.55,,,9.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.43,,,6.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.95,,,11.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.37,,,6.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.04,,,11.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.37,,,6.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.13,12.47,
LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%,Rx76329630005,CDM,,,250,RC,76329-6300-05,NDC,,BOTH,1,EA,12.99,10.02,12.34,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.13,,,10.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,10.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,6.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,10.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.47,,,12.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.55,,,10.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.43,,,10.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.95,,,11.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.04,,,11.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.34,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.13,12.47,
"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%",Rx76329630005,CDM,,,250,RC,76329-6300-05,NDC,,BOTH,1,EA,12.99,29.09,12.34,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.13,,,10.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,10.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,6.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,10.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.47,,,12.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.55,,,10.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.43,,,10.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.95,,,11.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.04,,,11.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.34,,,11.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.37,,,6.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.13,12.47,
BUDESONIDE INHALATION SUSP 0.25 MG/2ML,Rx00487960101,CDM,J7626,HCPCS,636,RC,487960101,NDC,,BOTH,2,ML,13.2,11.88,12.54,,,11.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.3,,,10.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,6.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.47,,,6.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,11.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.67,,,12.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.7,,,10.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.47,,,10.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.14,,,12.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.47,,,6.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.22,,,11.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.54,,,11.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,12.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.47,,,6.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.3,12.67,
HC DUODERM SIGNAL 4X4 DRESSING FILM BACKING W/BORDER,Sx00000403326,CDM,,,270,RC,,,,BOTH,,,13.31,11.98,12.64,,,11.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.38,,,10.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,11.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,6.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,11.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.52,,,6.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,11.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.78,,,12.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.78,,,10.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.59,,,10.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.52,,,6.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.31,,,11.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.64,,,11.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,12.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.52,,,6.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.38,12.78,
HC HEMOGLOBIN,Px00030510023,CDM,85018,CPT,300,RC,,,,BOTH,,,13.36,12.02,12.69,,,12.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.42,,,10.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,11.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,6.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,11.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,12.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.83,,,12.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.82,,,10.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.61,,,10.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.36,,,11.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.69,,,12.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,12.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.42,12.83,
HC BLOOD COUNT HEMOGLOBIN #,Px00030500112,CDM,85018,CPT,300,RC,,,,BOTH,,,13.36,12.02,12.69,,,12.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.42,,,10.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,11.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,6.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,11.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,12.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.83,,,12.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.82,,,10.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.61,,,10.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.36,,,11.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.69,,,12.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.02,,,12.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.55,,,6.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.42,12.83,
PHENOL LIQUID 1.4%,Rx00536122858,CDM,,,250,RC,00536-1228-58,NDC,,BOTH,1,EA,13.38,10.31,12.71,,,12.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.44,,,10.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,11.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,6.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,11.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.56,,,6.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,12.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.84,,,12.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.83,,,10.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.62,,,10.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.31,,,12.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.56,,,6.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.37,,,11.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.71,,,12.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,12.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.56,,,6.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.44,12.84,
FENTANYL TD PATCH 72HR 75 MCG/HR,Rx60505700800,CDM,,,250,RC,60505-7008-00,NDC,,BOTH,0.1,ME,13.41,12.07,12.74,,,12.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.46,,,10.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,11.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,6.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,11.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.57,,,6.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,12.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.87,,,12.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.86,,,10.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.64,,,10.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.34,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.57,,,6.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.4,,,11.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.74,,,12.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,12.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.57,,,6.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.46,12.87,
MODAFINIL TAB 200 MG,Rx68084072121,CDM,,,250,RC,68084-0721-21,NDC,,BOTH,200,ME,13.44,11.97,12.77,,,12.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.48,,,10.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.59,,,6.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.9,,,12.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.88,,,9.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.65,,,6.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.36,,,12.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.59,,,6.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.42,,,11.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.77,,,12.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.59,,,6.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.48,12.9,
TOBRAMYCIN OPHTH SOLN 0.3%,Rx17478029010,CDM,,,250,RC,17478-0290-10,NDC,,BOTH,1,EA,13.66,12.29,12.98,,,12.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.65,,,10.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.69,,,6.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.11,,,13.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.04,,,10.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.76,,,6.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.57,,,12.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.69,,,6.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.61,,,11.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.98,,,12.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.69,,,6.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.65,13.11,
SITAGLIPTIN PHOSPHATE TAB 50 MG (BASE EQUIV),Rx00006011201,CDM,,,250,RC,00006-0112-01,NDC,,BOTH,50,ME,13.76,12.38,13.07,,,19.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.73,,,16.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.38,,,18.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.38,,,11.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.38,,,18.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.74,,,11.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.38,,,19.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.21,,,20.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.11,,,16.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.81,,,16.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,20.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.74,,,11.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.7,,,18.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,19.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.38,,,20.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.74,,,6.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.73,13.21,
AZITHROMYCIN FOR SUSP 200 MG/5ML,Rx59762312001,CDM,,,250,RC,59762-3120-01,NDC,,BOTH,5,ML,13.87,12.48,13.18,,,13.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.82,,,10.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,,,12.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,,,12.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,,,12.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.8,,,6.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,,,12.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.32,,,13.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.19,,,10.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.86,,,6.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.76,,,12.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.8,,,6.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.79,,,11.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.18,,,13.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,,,12.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.8,,,6.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.82,13.32,
HC EYE PATCH PRESS PATCH,Px00000826WNH,CDM,,,270,RC,,,,BOTH,,,14,12.6,13.3,,,12.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.92,,,10.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,11.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,7.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,11.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,7.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,12.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.44,,,13.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.29,,,10.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6.93,,,10.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.88,,,12.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,7.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.9,,,11.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.3,,,12.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,13.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6.86,,,6.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.92,13.44,
TOBRAMYCIN OPHTH SOLN 0.3%,Rx24208029005,CDM,,,250,RC,24208-0290-05,NDC,,BOTH,1,EA,14.17,12.75,13.46,,,13.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.05,,,11.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.94,,,6.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.6,,,13.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.41,,,10.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.01,,,7.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.04,,,13.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.94,,,6.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.04,,,12.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.46,,,13.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.94,,,6.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.05,13.6,
BUDESONIDE INHALATION SUSP 0.25 MG/2ML,Rx00186198804,CDM,J7626,HCPCS,636,RC,186198804,NDC,,BOTH,2,ML,14.22,12.8,13.51,,,13.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.09,,,11.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,,,12.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,,,12.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,,,12.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,,,12.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.65,,,13.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.45,,,10.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.08,,,13.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.09,,,12.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.51,,,13.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,,,12.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6.97,,,6.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.09,13.65,
HC TEGADERM SILICONE FOAM 2X2 DRESSING,Px00013048WNH,CDM,,,270,RC,,,,BOTH,,,14.42,12.98,13.7,,,12.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.25,,,11.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.98,,,12.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.98,,,7.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.98,,,12.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.07,,,7.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.98,,,12.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.6,,,11.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.14,,,11.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.27,,,13.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.07,,,7.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.26,,,12.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.7,,,12.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.98,,,13.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.07,,,7.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.25,13.84,
METFORMIN HCL TAB ER 24HR OSMOTIC 500 MG,Rx00378600291,CDM,,,250,RC,00378-6002-91,NDC,,BOTH,500,ME,14.48,13.04,13.76,,,13.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.29,,,11.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.03,,,12.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.03,,,7.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.03,,,12.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.1,,,7.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.03,,,13.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.9,,,13.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.64,,,11.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.17,,,11.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.32,,,13.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.1,,,7.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.31,,,12.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.76,,,13.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.03,,,13.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.1,,,7.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.29,13.9,
SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,Rx10019055304,CDM,,,250,RC,10019-0553-04,NDC,,BOTH,1,ME,14.81,13.34,14.07,,,13.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.55,,,11.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,7.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,7.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,13.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.22,,,14.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.89,,,11.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.33,,,11.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.63,,,13.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,7.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.59,,,12.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.07,,,13.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,14.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.26,,,7.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.55,14.22,
OSELTAMIVIR PHOSPHATE CAP 45 MG (BASE EQUIV),Rx00004080185,CDM,,,250,RC,00004-0801-85,NDC,,BOTH,45,ME,15.02,13.53,14.27,,,16.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.72,,,14.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,15.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,9.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,15.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.36,,,9.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,16.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,17.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.04,,,14.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.43,,,14.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.82,,,17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.36,,,9.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.77,,,15.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,16.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,17.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.36,,,7.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.72,14.42,
ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,Rx00000003407,CDM,,,250,RC,00000-0034-07,NDC,,BOTH,5,ML,15.12,13.61,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.79,,,11.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.61,,,13.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.61,,,13.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.61,,,13.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.41,,,7.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.61,,,13.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.52,,,14.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.11,,,11.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.48,,,7.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.91,,,13.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.41,,,7.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.85,,,12.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.61,,,13.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.41,,,7.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.79,14.52,
HC PATCH EYE CONVEX BLACK,Sx00000004475,CDM,,,270,RC,,,,BOTH,,,15.16,12.59,14.4,,,12.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.82,,,10.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.64,,,11.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.64,,,7.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.64,,,11.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.43,,,7.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.64,,,12.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,13.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.14,,,10.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.5,,,10.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.95,,,12.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.43,,,7.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.89,,,11.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,12.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.64,,,13.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.43,,,7.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.82,14.55,
LEVONORGESTREL TAB 1.5 MG,Rx68180085211,CDM,,,250,RC,68180-0852-11,NDC,,BOTH,1.5,ME,15.28,13.52,14.52,,,14.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.92,,,11.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.75,,,13.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.75,,,13.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.75,,,13.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.49,,,7.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.75,,,13.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.67,,,14.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.23,,,11.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.56,,,7.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.06,,,14.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.49,,,7.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.99,,,12.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.52,,,14.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.75,,,13.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.49,,,7.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.92,14.67,
SITAGLIPTIN PHOSPHATE TAB 50 MG (BASE EQUIV),Rx00006011231,CDM,,,250,RC,00006-0112-31,NDC,,BOTH,50,ME,15.37,13.31,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.99,,,11.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.83,,,13.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.83,,,13.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.83,,,13.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.53,,,7.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.83,,,13.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.76,,,14.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.3,,,11.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.61,,,7.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.53,,,7.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.06,,,13.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.83,,,13.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.53,,,7.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.99,14.76,
SITAGLIPTIN PHOSPHATE TAB 50 MG (BASE EQUIV),Rx00006011228,CDM,,,250,RC,00006-0112-28,NDC,,BOTH,50,ME,15.38,13.31,14.61,,,14.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12,,,12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.76,,,14.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.3,,,11.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.61,,,7.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.07,,,13.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.61,,,14.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.84,,,13.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.54,,,7.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12,14.76,
FENTANYL TD PATCH 72HR 12 MCG/HR,Rx00378911916,CDM,,,250,RC,00378-9119-16,NDC,,BOTH,0.012,ME,15.48,13.93,14.71,,,13.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.07,,,12.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,12.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,7.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,12.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.59,,,7.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,13.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,14.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.38,,,12.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.66,,,12.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.59,,,7.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.16,,,13.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,13.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,14.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.59,,,7.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.07,14.86,
OFLOXACIN OTIC SOLN 0.3%,Rx24208041005,CDM,,,250,RC,24208-0410-05,NDC,,BOTH,1,EA,15.51,13.96,14.73,,,14.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,,,12.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,,,7.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.89,,,14.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.4,,,11.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.68,,,7.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.27,,,14.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,,,7.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.18,,,13.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.73,,,14.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.6,,,7.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.1,14.89,
HC CALCIUM ALGINATE 4X4 *LF,Px00005261WNH,CDM,,,270,RC,,,,BOTH,,,15.68,14.11,14.9,,,14.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.23,,,12.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.11,,,13.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.11,,,7.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.11,,,13.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.68,,,7.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.11,,,14.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,15.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.52,,,12.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,12.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.43,,,14.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.68,,,7.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.33,,,13.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.9,,,14.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.11,,,14.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.68,,,7.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.23,15.05,
BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT,Rx00310737020,CDM,,,250,RC,00310-7370-20,NDC,,BOTH,1,EA,15.7,14.13,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.07,,,15.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.54,,,11.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.77,,,7.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.44,,,14.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.35,,,13.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,15.07,
ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV),Rx00781729685,CDM,,,250,RC,00781-7296-85,NDC,,BOTH,0.09,ME,15.7,25.97,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.07,,,15.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.54,,,11.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.77,,,7.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.44,,,14.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.35,,,13.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.13,,,14.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.69,,,7.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,15.07,
METOPROLOL TARTRATE TAB 25 MG,Rx57237010001,CDM,,,250,RC,57237-0100-01,NDC,,BOTH,25,ME,15.71,14.14,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.55,,,11.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.77,,,7.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.45,,,14.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.35,,,13.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,15.08,
METOPROLOL TARTRATE TAB 25 MG,Rx65862006201,CDM,,,250,RC,65862-0062-01,NDC,,BOTH,25,ME,15.71,14.14,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,,,12.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.55,,,11.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.77,,,7.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.45,,,14.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.35,,,13.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.92,,,14.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.14,,,14.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,15.08,
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG,Rx13668009390,CDM,,,250,RC,13668-0093-90,NDC,,BOTH,0.5,ME,15.71,14.14,14.92,,,14.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.14,,,13.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.14,,,8.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.14,,,13.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.7,,,8.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.14,,,14.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,15.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.55,,,12.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,12.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,14.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.7,,,8.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.35,,,13.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.92,,,14.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.14,,,14.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.25,15.08,
METOPROLOL TARTRATE TAB 25 MG,Rx00904634061,CDM,,,250,RC,00904-6340-61,NDC,,BOTH,25,ME,15.72,14.15,14.93,,,14.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.26,,,12.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.09,,,15.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.55,,,11.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.36,,,13.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.93,,,14.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.26,15.09,
METOPROLOL TARTRATE TAB 25 MG,Rx51079025501,CDM,,,250,RC,51079-0255-01,NDC,,BOTH,25,ME,15.72,14.15,14.93,,,14.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.26,,,12.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.09,,,15.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.55,,,11.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.36,,,13.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.93,,,14.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.15,,,14.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.7,,,7.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.26,15.09,
METOPROLOL TARTRATE TAB 25 MG,Rx62584026511,CDM,,,250,RC,62584-0265-11,NDC,,BOTH,25,ME,15.73,14.16,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.27,,,12.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.16,,,14.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.16,,,14.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.16,,,14.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.16,,,14.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.1,,,15.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.56,,,11.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.37,,,13.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.16,,,14.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.71,,,7.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.27,15.1,
PREDNISONE TAB 20 MG,Rx60687014511,CDM,J7512,HCPCS,636,RC,60687014511,NDC,,BOTH,20,ME,15.73,14.16,14.94,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.27,,,12.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,8.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.71,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.1,,,15.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.56,,,12.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.71,,,12.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,14.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.71,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.37,,,13.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.94,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,15.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.71,,,7.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.27,15.1,
PREDNISONE TAB 20 MG,Rx00054001820,CDM,J7512,HCPCS,636,RC,54001820,NDC,,BOTH,20,ME,15.75,14.18,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.58,,,11.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.39,,,13.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,15.12,
CHARCOAL ACTIVATED LIQ,Rx00574052176,CDM,,,250,RC,00574-0521-76,NDC,,BOTH,1,EA,15.75,13.69,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.58,,,11.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.39,,,13.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,15.12,
QUETIAPINE FUMARATE TAB ER 24HR 200 MG,Rx68001051306,CDM,,,250,RC,68001-0513-06,NDC,,BOTH,200,ME,15.76,14.18,14.97,,,14.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,,,12.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.13,,,15.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.58,,,11.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.97,,,14.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.18,,,14.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.72,,,7.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.29,15.13,
PREDNISONE TAB 10 MG,Rx60687013411,CDM,J7512,HCPCS,636,RC,60687013411,NDC,,BOTH,10,ME,15.77,14.19,14.98,,,14.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.3,,,12.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.19,,,14.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.19,,,14.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.19,,,14.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.19,,,14.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.14,,,15.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.59,,,11.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.51,,,14.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.98,,,14.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.19,,,14.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.3,15.14,
TOPIRAMATE TAB 100 MG,Rx68084034411,CDM,,,250,RC,68084-0344-11,NDC,,BOTH,100,ME,15.77,14.19,14.98,,,14.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.3,,,12.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,8.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.59,,,12.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,12.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.51,,,14.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.4,,,13.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.98,,,14.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.3,15.14,
MICONAZOLE NITRATE POWDER 2%,Rx00316022515,CDM,,,250,RC,00316-0225-15,NDC,,BOTH,1,EA,15.78,14.2,14.99,,,14.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.31,,,12.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,13.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,8.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,13.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,14.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.15,,,15.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.6,,,12.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,12.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.52,,,14.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.41,,,13.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,14.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.31,15.15,
ZONISAMIDE CAP 100 MG,Rx69097086107,CDM,,,250,RC,69097-0861-07,NDC,,BOTH,100,ME,15.78,14.2,14.99,,,14.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.31,,,12.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,13.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,8.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,13.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,14.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.15,,,15.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.6,,,12.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.81,,,12.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.52,,,14.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,8.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.41,,,13.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,14.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.2,,,15.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.73,,,7.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.31,15.15,
ZONISAMIDE CAP 100 MG,Rx50268081611,CDM,,,250,RC,50268-0816-11,NDC,,BOTH,100,ME,15.79,14.21,15,,,15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,,,12.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.61,,,11.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.81,,,7.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.42,,,13.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15,,,15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,15.16,
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG,Rx60687058111,CDM,,,250,RC,60687-0581-11,NDC,,BOTH,0.5,ME,15.79,14.21,15,,,15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,,,12.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.61,,,11.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.81,,,7.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.42,,,13.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15,,,15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,15.16,
ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML),Rx00487950101,CDM,J7613,HCPCS,636,RC,487950101,NDC,,BOTH,3,ML,15.79,14.21,15,,,14.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.32,,,12.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,69.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,69.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.61,,,12.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,12.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.53,,,14.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,8.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.42,,,13.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15,,,14.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,15.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,15.16,
PREDNISONE TAB 10 MG,Rx00054001720,CDM,J7512,HCPCS,636,RC,54001720,NDC,,BOTH,10,ME,15.79,14.21,15,,,14.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.32,,,12.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,8.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,8.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.61,,,12.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,12.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.53,,,14.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,8.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.42,,,13.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15,,,14.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.74,,,7.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.32,15.16,
FAMOTIDINE 20 MG (ED PREPACK-OR) PO TABS,Rx00000005840,CDM,,,250,RC,00000-0058-40,NDC,,BOTH,20,ME,15.81,14.23,15.02,,,14.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.33,,,12.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,8.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.18,,,15.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.62,,,12.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.82,,,12.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.44,,,13.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.02,,,14.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,15.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.33,15.18,
SODIUM CHLORIDE SOLN NEBU 0.9%,Rx00487930133,CDM,,,250,RC,00487-9301-33,NDC,,BOTH,1,EA,15.81,14.23,15.02,,,14.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.33,,,12.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,8.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.18,,,15.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.62,,,12.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.82,,,12.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.44,,,13.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.02,,,14.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,15.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.33,15.18,
QUETIAPINE FUMARATE TAB ER 24HR 200 MG,Rx50742063760,CDM,,,250,RC,50742-0637-60,NDC,,BOTH,200,ME,15.81,14.23,15.02,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.33,,,12.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,8.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,13.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.18,,,15.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.62,,,12.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.82,,,12.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.44,,,13.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.02,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,15.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.33,15.18,
PREDNISONE TAB 5 MG,Rx60687012211,CDM,J7512,HCPCS,636,RC,60687012211,NDC,,BOTH,5,ME,15.82,14.24,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.19,,,15.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.45,,,13.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML),Rx60687039579,CDM,J7613,HCPCS,636,RC,60687039579,NDC,,BOTH,3,ML,15.82,14.21,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.19,,,15.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.45,,,13.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
WARFARIN SODIUM TAB 1 MG,Rx00832121189,CDM,,,250,RC,00832-1211-89,NDC,,BOTH,1,ME,15.82,14.24,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.19,,,15.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.45,,,13.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
SUMATRIPTAN SUCCINATE TAB 100 MG,Rx69452034660,CDM,,,250,RC,69452-0346-60,NDC,,BOTH,100,ME,15.82,14.24,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,,,12.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.19,,,15.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.55,,,14.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.45,,,13.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
LEVETIRACETAM TAB 500 MG,Rx50474059540,CDM,,,250,RC,50474-0595-40,NDC,,BOTH,500,ME,15.82,13.73,15.03,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.34,,,12.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,13.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,8.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,13.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,12.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.45,,,13.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.03,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,15.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
SUMATRIPTAN SUCCINATE TAB 100 MG,Rx65862014836,CDM,,,250,RC,65862-0148-36,NDC,,BOTH,100,ME,15.82,14.24,15.03,,,14.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.34,,,12.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,13.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,8.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,13.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,14.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,12.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,8.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.45,,,13.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.03,,,14.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.24,,,15.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.75,,,7.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.34,15.19,
TORSEMIDE TAB 20 MG,Rx50268075611,CDM,,,250,RC,50268-0756-11,NDC,,BOTH,20,ME,15.83,14.25,15.04,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.35,,,12.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,13.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,8.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,13.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,8.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.2,,,15.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.64,,,12.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,12.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.56,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,8.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.46,,,13.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.04,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,15.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,7.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.35,15.2,
QUETIAPINE FUMARATE TAB ER 24HR 400 MG,Rx50228038460,CDM,,,250,RC,50228-0384-60,NDC,,BOTH,400,ME,15.83,14.25,15.04,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.35,,,13.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,13.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,8.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,13.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.2,,,16.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.64,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.56,,,15.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.46,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.04,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,15.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.76,,,7.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.35,15.2,
TORSEMIDE TAB 20 MG,Rx68084053911,CDM,,,250,RC,68084-0539-11,NDC,,BOTH,20,ME,15.84,14.26,15.05,,,15.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.36,,,12.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.26,,,14.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.26,,,14.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.26,,,14.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.76,,,7.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.26,,,14.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.21,,,15.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.64,,,11.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.84,,,7.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.57,,,14.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.76,,,7.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.46,,,13.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.05,,,15.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.26,,,14.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.76,,,7.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.36,15.21,
PREDNISONE TAB 5 MG,Rx60687012201,CDM,J7512,HCPCS,636,RC,60687012201,NDC,,BOTH,5,ME,15.85,14.27,15.06,,,14.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.36,,,12.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,8.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.22,,,15.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.65,,,12.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,12.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.58,,,14.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,8.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.47,,,13.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,14.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.77,,,7.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.36,15.22,
ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML),Rx76204020001,CDM,J7613,HCPCS,636,RC,76204020001,NDC,,BOTH,3,ML,15.87,14.2,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.38,,,12.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.24,,,15.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.66,,,11.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.49,,,13.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.38,15.24,
OXYMETAZOLINE HCL NASAL SOLN 0.05%,Rx45802041059,CDM,,,250,RC,45802-0410-59,NDC,,BOTH,1,EA,15.87,14.28,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.38,,,12.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.24,,,15.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.66,,,11.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.85,,,7.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.49,,,13.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.08,,,15.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.78,,,7.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.38,15.24,
IPRATROPIUM BROMIDE INHAL SOLN 0.02%,Rx00487980101,CDM,J7644,HCPCS,636,RC,487980101,NDC,,BOTH,0.5,UN,15.89,14.3,15.1,,,15.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.39,,,12.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.3,,,14.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.3,,,14.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.3,,,14.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.3,,,14.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.25,,,15.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.68,,,11.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.62,,,14.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.51,,,13.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.1,,,15.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.3,,,14.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.39,15.25,
IPRATROPIUM BROMIDE INHAL SOLN 0.02%,Rx60687039479,CDM,J7644,HCPCS,636,RC,60687039479,NDC,,BOTH,0.5,UN,15.89,14.3,15.1,,,14.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.39,,,12.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,8.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,8.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,15.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.68,,,12.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,12.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,14.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,8.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.51,,,13.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.1,,,14.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.39,15.25,
METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV),Rx00904632361,CDM,,,250,RC,00904-6323-61,NDC,,BOTH,50,ME,15.89,14.29,15.1,,,14.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.39,,,12.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,13.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,8.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,13.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,8.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,15.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.68,,,12.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.86,,,12.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,8.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.51,,,13.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.1,,,14.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.79,,,7.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.39,15.25,
ACETYLCYSTEINE INHAL SOLN 20%,Rx63323069044,CDM,J7608,HCPCS,636,RC,63323069044,NDC,,BOTH,1,UN,15.91,14.32,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.41,,,12.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.64,,,14.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.52,,,13.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.41,15.27,
PROPRANOLOL HCL TAB 10 MG,Rx60687058711,CDM,,,250,RC,60687-0587-11,NDC,,BOTH,10,ME,15.91,14.32,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.41,,,12.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.69,,,11.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.64,,,14.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.52,,,13.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.32,,,14.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.41,15.27,
ACETYLCYSTEINE INHAL SOLN 20%,Rx63323069041,CDM,J7608,HCPCS,636,RC,63323069041,NDC,,BOTH,1,UN,15.91,14.32,15.11,,,14.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.41,,,12.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.32,,,13.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.32,,,8.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.32,,,13.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.32,,,14.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.27,,,15.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.69,,,12.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,12.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.64,,,14.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,13.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,14.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.32,,,15.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.41,15.27,
POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,Rx00245531789,CDM,,,250,RC,00245-5317-89,NDC,,BOTH,1,EA,15.92,14.33,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.42,,,12.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.28,,,15.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.7,,,11.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.65,,,14.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.53,,,13.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.42,15.28,
PROMETHAZINE HCL 25 MG (ED PREPACK-OR) PO TABS,Rx00000003554,CDM,,,250,RC,00000-0035-54,NDC,,BOTH,25,ME,15.92,14.33,15.12,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.42,,,12.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,8.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.28,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.7,,,12.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,12.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.65,,,14.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.53,,,13.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.12,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,15.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.42,15.28,
PROPRANOLOL HCL TAB 10 MG,Rx60687058701,CDM,,,250,RC,60687-0587-01,NDC,,BOTH,10,ME,15.92,14.27,15.12,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.42,,,12.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,8.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.28,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.7,,,12.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,12.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.65,,,14.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,8.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.53,,,13.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.12,,,14.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.33,,,15.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.8,,,7.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.42,15.28,
METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV),Rx60687040201,CDM,,,250,RC,60687-0402-01,NDC,,BOTH,50,ME,15.96,14.36,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.45,,,12.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.32,,,15.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.73,,,11.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.9,,,7.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.57,,,13.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.45,15.32,
SODIUM CHLORIDE SOLN NEBU 0.9%,Rx76204030003,CDM,,,250,RC,76204-0300-03,NDC,,BOTH,1,EA,15.96,14.29,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.45,,,12.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.32,,,15.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.73,,,11.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.9,,,7.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.57,,,13.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.36,,,14.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.82,,,7.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.45,15.32,
CYCLOBENZAPRINE HCL 10 MG (ED PREPACK-OR) PO TABS,Rx00000005893,CDM,,,250,RC,00000-0058-93,NDC,,BOTH,10,ME,15.97,14.37,15.17,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.46,,,12.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.37,,,13.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.37,,,8.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.37,,,13.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,8.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.37,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.33,,,15.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.74,,,12.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.9,,,12.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.69,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,8.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.57,,,13.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.17,,,14.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.37,,,15.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.46,15.33,
IPRATROPIUM BROMIDE INHAL SOLN 0.02%,Rx76204010060,CDM,J7644,HCPCS,636,RC,76204010060,NDC,,BOTH,0.5,UN,15.98,14.27,15.18,,,15.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.46,,,12.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.34,,,15.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.75,,,11.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.7,,,14.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.58,,,13.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.18,,,15.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.83,,,7.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.46,15.34,
EMPAGLIFLOZIN TAB 10 MG,Rx00597015237,CDM,,,250,RC,00597-0152-37,NDC,,BOTH,10,ME,15.99,15.71,15.19,,,16.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.47,,,13.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.39,,,14.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.39,,,9.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.39,,,14.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,9.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.39,,,16.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.35,,,17.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.75,,,13.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,13.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,16.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,9.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.59,,,15.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,16.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.39,,,17.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,7.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.47,15.35,
POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,Rx00245531701,CDM,,,250,RC,00245-5317-01,NDC,,BOTH,1,EA,16,14.3,15.2,,,14.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.48,,,12.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,13.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,8.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,13.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,8.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,14.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.36,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,12.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,12.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.72,,,14.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,8.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.6,,,13.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.2,,,14.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,15.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,7.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.48,15.36,
LOSARTAN POTASSIUM TAB 25 MG,Rx50268050411,CDM,,,250,RC,50268-0504-11,NDC,,BOTH,25,ME,16.01,14.41,15.21,,,14.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.49,,,12.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,13.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,8.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,13.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,8.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,14.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.37,,,15.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.77,,,12.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,12.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.73,,,14.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,8.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.61,,,13.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.21,,,14.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,15.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.84,,,7.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.49,15.37,
METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV),Rx60687041311,CDM,,,250,RC,60687-0413-11,NDC,,BOTH,100,ME,16.02,14.42,15.22,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.5,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,14.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,8.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,14.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.85,,,8.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.38,,,16.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.77,,,13.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.93,,,13.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,15.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.85,,,8.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.62,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.22,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,16.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.85,,,7.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.5,15.38,
OXYCODONE-ACETAMINOPHEN 5-325 MG (ED PREPACK-OR) PO TABS,Rx00000003693,CDM,,,250,RC,00000-0036-93,NDC,,BOTH,1,EA,16.04,14.44,15.24,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.51,,,12.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,13.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,8.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,13.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.86,,,8.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.4,,,15.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.79,,,12.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.94,,,12.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.76,,,14.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.86,,,8.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.63,,,13.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.24,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.86,,,7.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.51,15.4,
DIPHENHYDRAMINE HCL 25 MG (ED PREPACK-OR) PO TABS,Rx00000005838,CDM,,,250,RC,00000-0058-38,NDC,,BOTH,25,ME,16.06,14.45,15.26,,,14.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.53,,,12.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,13.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,8.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,13.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.42,,,15.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.8,,,12.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,12.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.65,,,13.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,14.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,15.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,15.42,
TRAMADOL HCL 50 MG (ED PREPACK-OR) PO TABS,Rx00000005897,CDM,,,250,RC,00000-0058-97,NDC,,BOTH,50,ME,16.06,14.45,15.26,,,14.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.53,,,12.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,13.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,8.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,13.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,14.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.42,,,15.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.8,,,12.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,12.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.65,,,13.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,14.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,15.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,15.42,
POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,Rx60687063211,CDM,,,250,RC,60687-0632-11,NDC,,BOTH,1,EA,16.07,14.46,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,,,12.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.43,,,15.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.81,,,11.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.95,,,7.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.66,,,13.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,15.43,
POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,Rx68084063201,CDM,,,250,RC,68084-0632-01,NDC,,BOTH,1,EA,16.07,14.46,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,,,12.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.43,,,15.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.81,,,11.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.95,,,7.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.66,,,13.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.46,,,14.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,15.43,
METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),Rx50268054011,CDM,,,250,RC,50268-0540-11,NDC,,BOTH,25,ME,16.07,14.46,15.27,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.53,,,12.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.46,,,13.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.46,,,8.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.46,,,13.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.46,,,14.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.43,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.81,,,12.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,12.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,14.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.66,,,13.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.27,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.46,,,15.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.87,,,7.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.53,15.43,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx76204060030,CDM,J7620,HCPCS,636,RC,76204060030,NDC,,BOTH,3,ML,16.08,14.47,15.28,,,15.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.54,,,12.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.44,,,15.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.82,,,11.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.79,,,14.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.67,,,13.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.28,,,15.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.54,15.44,
PRIMIDONE TAB 50 MG,Rx68084020211,CDM,,,250,RC,68084-0202-11,NDC,,BOTH,50,ME,16.08,14.47,15.28,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.54,,,12.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,13.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,8.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,13.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,14.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.44,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.82,,,12.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.96,,,12.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.79,,,14.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,8.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.67,,,13.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.28,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,15.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.88,,,7.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.54,15.44,
SUMATRIPTAN SUCCINATE TAB 100 MG,Rx62756052269,CDM,,,250,RC,62756-0522-69,NDC,,BOTH,100,ME,16.1,14.49,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.56,,,12.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.83,,,11.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.81,,,14.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.69,,,13.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.49,,,14.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.56,15.46,
PYRIDOSTIGMINE BROMIDE TAB 60 MG,Rx60687050211,CDM,,,250,RC,60687-0502-11,NDC,,BOTH,60,ME,16.11,14.5,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.57,,,12.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.47,,,15.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.84,,,11.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.82,,,14.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.69,,,13.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.5,,,14.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.89,,,7.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.57,15.47,
POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,Rx68084063211,CDM,,,250,RC,68084-0632-11,NDC,,BOTH,1,EA,16.14,14.53,15.33,,,15.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.59,,,12.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.49,,,15.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.86,,,11.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.85,,,14.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.72,,,13.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.33,,,15.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.53,,,14.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.59,15.49,
METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV),Rx60687040211,CDM,,,250,RC,60687-0402-11,NDC,,BOTH,50,ME,16.15,14.54,15.34,,,15.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,,,12.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.5,,,15.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.87,,,11.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.86,,,14.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.73,,,13.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.34,,,15.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,15.5,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG (ED PREPACK-OR) PO TABS,Rx00000005896,CDM,,,250,RC,00000-0058-96,NDC,,BOTH,1,EA,16.15,14.54,15.34,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.6,,,12.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.54,,,13.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.54,,,8.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.54,,,13.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,8.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.5,,,15.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.87,,,12.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,12.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,14.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,8.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.73,,,13.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,14.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.54,,,15.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.91,,,7.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,15.5,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx00378967130,CDM,J7620,HCPCS,636,RC,378967130,NDC,,BOTH,3,ML,16.16,14.54,15.35,,,15.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,,,12.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.51,,,15.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.88,,,11.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.87,,,14.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.74,,,13.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.35,,,15.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,15.51,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx00487020101,CDM,J7620,HCPCS,636,RC,487020101,NDC,,BOTH,3,ML,16.16,14.54,15.35,,,15.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,,,12.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.51,,,15.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.88,,,11.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.87,,,14.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.74,,,13.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.35,,,15.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.6,15.51,
BUPRENORPHINE HCL-NALOXONE HCL SL FILM 4-1 MG (BASE EQUIV),Rx12496120401,CDM,J0573,HCPCS,636,RC,12496120401,NDC,,BOTH,1,ME,16.17,14.55,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.61,,,12.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,13.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,8.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,13.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,8.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,15.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,14.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,8.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.74,,,13.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.61,15.52,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx60687040579,CDM,J7620,HCPCS,636,RC,60687040579,NDC,,BOTH,3,ML,16.17,14.55,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.61,,,12.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,70,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,70,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,15.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,14.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,8.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.74,,,13.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.61,15.52,
BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV),Rx12496120801,CDM,,,250,RC,12496-1208-01,NDC,,BOTH,1,EA,16.17,14.55,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.61,,,12.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,13.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,8.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,13.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,8.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,15.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8,,,12.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,14.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,8.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.74,,,13.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.36,,,14.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.55,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.92,,,7.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.61,15.52,
AMOXICILLIN (TRIHYDRATE) CAP 500 MG,Rx00000005891,CDM,,,250,RC,00000-0058-91,NDC,,BOTH,500,ME,16.19,14.57,15.38,,,14.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.63,,,12.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.57,,,13.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.57,,,8.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.57,,,13.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.93,,,8.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.57,,,14.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.54,,,15.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.9,,,12.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.01,,,12.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.89,,,14.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.93,,,8.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.76,,,13.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.38,,,14.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.57,,,15.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.93,,,7.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.63,15.54,
KETOROLAC TROMETHAMINE TAB 10 MG,Rx00000005842,CDM,,,250,RC,00000-0058-42,NDC,,BOTH,10,ME,16.21,14.59,15.4,,,17.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.64,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.59,,,16.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.59,,,10.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.59,,,16.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.94,,,10.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.59,,,17.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.56,,,19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.91,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.02,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,18.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.94,,,10.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.78,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.4,,,17.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.59,,,18.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.94,,,7.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.64,15.56,
PRAZOSIN HCL CAP 5 MG,Rx60687057233,CDM,,,250,RC,60687-0572-33,NDC,,BOTH,5,ME,16.22,14.6,15.41,,,16.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.65,,,14.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.6,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.6,,,9.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.6,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,9.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.6,,,16.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.57,,,17.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.92,,,14.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,14.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.92,,,16.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,9.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.79,,,15.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.41,,,16.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.6,,,17.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,7.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.65,15.57,
HYDROXYCHLOROQUINE SULFATE TAB 200 MG,Rx50268041211,CDM,,,250,RC,50268-0412-11,NDC,,BOTH,200,ME,16.23,14.61,15.42,,,15.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,13.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,13.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,8.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,13.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,15.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.58,,,16.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.93,,,13.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,13.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.93,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.8,,,14.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.42,,,15.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,15.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.95,,,7.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.66,15.58,
ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV),Rx00378705852,CDM,J7613,HCPCS,636,RC,378705852,NDC,,BOTH,3,ML,16.24,14.68,15.43,,,14.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.67,,,12.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,70.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,70.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.96,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,14.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.59,,,15.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.94,,,12.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7.96,,,12.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.94,,,14.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.96,,,8.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.8,,,13.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.43,,,14.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.96,,,7.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.67,15.59,
AMMONIA AROMATIC INHALATION,Rx39822990002,CDM,,,250,RC,39822-9900-02,NDC,,BOTH,1,EA,16.25,14.63,15.44,,,15.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,,,12.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.96,,,7.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.94,,,11.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.04,,,8.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.95,,,14.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.96,,,7.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.81,,,13.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.44,,,15.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.96,,,7.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,15.6,
OXYCODONE HCL SOLN 5 MG/5ML,Rx60687040640,CDM,,,250,RC,60687-0406-40,NDC,,BOTH,5,ML,16.26,14.63,15.45,,,15.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,,,12.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.61,,,15.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.95,,,11.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.82,,,13.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.45,,,15.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,15.61,
PYRIDOSTIGMINE BROMIDE TAB 60 MG,Rx60687050201,CDM,,,250,RC,60687-0502-01,NDC,,BOTH,60,ME,16.26,14.63,15.45,,,15.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,,,12.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.61,,,15.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.95,,,11.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.96,,,14.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.82,,,13.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.45,,,15.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.63,,,14.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,15.61,
IBUPROFEN 600 MG (ED PREPACK-OR) PO TABS,Rx00000005841,CDM,,,250,RC,00000-0058-41,NDC,,BOTH,600,ME,16.26,14.63,15.45,,,14.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.68,,,12.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.63,,,13.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.63,,,8.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.63,,,13.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.97,,,8.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.63,,,14.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.61,,,15.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.95,,,12.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.05,,,12.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.96,,,14.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.97,,,8.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.82,,,13.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.45,,,14.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.63,,,15.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.97,,,7.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.68,15.61,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx60687040583,CDM,J7620,HCPCS,636,RC,60687040583,NDC,,BOTH,3,ML,16.29,14.44,15.48,,,15.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.71,,,12.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.98,,,7.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.64,,,15.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.97,,,11.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.98,,,7.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.99,,,14.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.98,,,7.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.85,,,13.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.48,,,15.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.98,,,7.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.71,15.64,
NIMODIPINE 30 MG/ML (CONCENTRATE) PO LIQUID,Rx00000003220,CDM,,,250,RC,00000-0032-20,NDC,,BOTH,1,ML,16.29,14.66,15.48,,,14.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.71,,,12.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.66,,,13.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.66,,,8.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.66,,,13.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.98,,,8.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.66,,,14.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.64,,,15.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.97,,,12.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.06,,,12.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,14.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.98,,,8.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.85,,,13.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.48,,,14.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.66,,,15.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.98,,,7.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.71,15.64,
HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,Rx00000000590,CDM,,,250,RC,00000-0005-90,NDC,,BOTH,15,ML,16.3,14.67,15.49,,,14.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.71,,,12.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,13.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,8.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,13.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,14.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.65,,,15.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,12.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.07,,,12.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15,,,15.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.86,,,13.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.49,,,14.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,15.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.71,15.65,
IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,Rx76204060001,CDM,J7620,HCPCS,636,RC,76204060001,NDC,,BOTH,3,ML,16.31,14.68,15.49,,,15.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.72,,,12.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.66,,,15.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.99,,,11.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.01,,,15.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.86,,,13.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.49,,,15.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.68,,,14.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.72,15.66,
HC DRESSING ALGISITE 4X4 CALCIUM SEAWEED,Sx00059480200,CDM,,,270,RC,,,,BOTH,,,16.31,14.68,15.49,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.72,,,12.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.68,,,13.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.68,,,8.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.68,,,13.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.68,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.66,,,15.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.99,,,12.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.07,,,12.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.01,,,15.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,8.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.86,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.49,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.68,,,15.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7.99,,,7.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.72,15.66,
PYRIDOXINE HCL INJ 100 MG/ML,Rx63323018001,CDM,,,250,RC,63323-0180-01,NDC,,BOTH,1,ML,16.34,22,15.52,,,15.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,,,12.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.71,,,14.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.71,,,14.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.71,,,14.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.71,,,14.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.69,,,15.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.01,,,12.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.09,,,8.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.03,,,15.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.89,,,13.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.52,,,15.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.71,,,14.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.01,,,8.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,15.69,
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%,Rx24208083060,CDM,,,250,RC,24208-0830-60,NDC,,BOTH,1,EA,16.34,14.26,15.52,,,14.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.75,,,12.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,13.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,8.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,13.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.01,,,8.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,14.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,15.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.01,,,12.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.09,,,12.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.03,,,14.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.01,,,8.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,13.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,14.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,15.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.01,,,8.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.75,15.69,
"HC XEROFOAM 1/8"" (3X)",Px00007182WNH,CDM,,,270,RC,,,,BOTH,,,16.38,14.74,15.56,,,14.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.78,,,12.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,13.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,8.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,13.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,8.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,14.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.72,,,15.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.04,,,12.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.11,,,12.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.07,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,8.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.92,,,13.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.56,,,14.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,15.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,8.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.78,15.72,
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%,Rx24208079535,CDM,,,250,RC,24208-0795-35,NDC,,BOTH,1,EA,16.39,14.76,15.57,,,29.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.78,,,25.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.75,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.75,,,16.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.75,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,16.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.75,,,29.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.73,,,31.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.05,,,25.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.11,,,25.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,30.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,16.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.93,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.57,,,29.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.75,,,31.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.03,,,8.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.78,15.73,
"HC DRESSING FOAM TEGADERM SILICONE 4"" x 4""",Sx00000090641,CDM,,,270,RC,,,,BOTH,,,16.41,27.44,15.59,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.8,,,12.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.77,,,13.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.77,,,8.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.77,,,13.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.04,,,8.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.77,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.75,,,15.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.06,,,12.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.12,,,12.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.1,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.04,,,8.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.95,,,13.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.59,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.77,,,15.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.04,,,8.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.8,15.75,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx00574052008,CDM,,,250,RC,00574-0520-08,NDC,,BOTH,1,EA,16.42,14.78,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.81,,,12.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.76,,,15.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.07,,,12.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.13,,,8.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.81,15.76,
CLOBETASOL PROPIONATE CREAM 0.05%,Rx13668056902,CDM,,,250,RC,13668-0569-02,NDC,,BOTH,1,EA,16.42,14.78,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.81,,,12.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.76,,,15.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.07,,,12.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.13,,,8.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.96,,,13.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.78,,,14.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.05,,,8.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.81,15.76,
LORAZEPAM 1 MG (ED PREPACK-OR) PO TABS,Rx00000003550,CDM,,,250,RC,00000-0035-50,NDC,,BOTH,1,ME,16.48,14.83,15.66,,,14.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.85,,,12.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,13.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,8.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,13.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,14.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.82,,,15.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.11,,,12.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,12.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.01,,,14.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.66,,,14.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,15.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.08,,,8.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.85,15.82,
ACETYLCYSTEINE INHAL SOLN 20%,Rx63323069030,CDM,J7608,HCPCS,636,RC,63323069030,NDC,,BOTH,1,UN,16.49,14.75,15.67,,,15.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.86,,,12.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.83,,,15.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.12,,,12.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.02,,,14.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.67,,,15.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.08,,,8.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.86,15.83,
FENTANYL TD PATCH 72HR 100 MCG/HR,Rx60505708400,CDM,,,250,RC,60505-7084-00,NDC,,BOTH,0.1,ME,16.53,14.88,15.7,,,15.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.89,,,12.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.1,,,8.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.87,,,15.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.15,,,12.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.18,,,8.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.21,,,15.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.1,,,8.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.05,,,14.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.7,,,15.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.1,,,8.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.89,15.87,
PREDNISONE 10 MG (ED PREPACK-OR) PO TABS,Rx00000005847,CDM,J7512,HCPCS,636,RC,5847,NDC,,BOTH,10,ME,16.57,14.91,15.74,,,14.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.92,,,12.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,13.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,8.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,13.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.12,,,8.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,14.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.91,,,15.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.18,,,12.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.12,,,12.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.24,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.12,,,8.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.08,,,14.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.74,,,14.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,15.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.12,,,8.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.92,15.91,
METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),Rx60687039011,CDM,,,250,RC,60687-0390-11,NDC,,BOTH,25,ME,16.6,14.94,15.77,,,15.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.95,,,12.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.13,,,8.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.94,,,15.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.2,,,12.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.22,,,8.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.13,,,8.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.11,,,14.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.77,,,15.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.13,,,8.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.95,15.94,
ACETAMINOPHEN-CODEINE 300-30 MG (ED PREPACK-OR) PO TABS,Rx00000005890,CDM,,,250,RC,00000-0058-90,NDC,,BOTH,30,ME,16.65,14.99,15.82,,,15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.99,,,12.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,8.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,14.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,15.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.24,,,12.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,12.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.32,,,15.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.15,,,14.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.82,,,15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,15.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.99,15.98,
ONDANSETRON 4 MG (ED PREPACK-OR) PO TBDP,Rx00000005898,CDM,,,250,RC,00000-0058-98,NDC,,BOTH,4,ME,16.66,14.99,15.83,,,15.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.99,,,13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,13.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,8.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,13.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.99,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.25,,,13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.33,,,15.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.16,,,14.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.83,,,15.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.99,,,15.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.16,,,8.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.99,15.99,
LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV),Rx00093414856,CDM,J7614,HCPCS,636,RC,93414856,NDC,,BOTH,3,ML,16.72,15.02,15.88,,,15.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.04,,,13.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,13.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,8.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,13.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,8.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,15.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.05,,,16.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.29,,,13.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,13.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.38,,,15.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,8.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.88,,,15.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,15.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.19,,,8.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.04,16.05,
AMOXICILLIN-POT CLAVULANATE 875-125 MG (ED PREPACK-OR) PO TABS,Rx00000003066,CDM,,,250,RC,00000-0030-66,NDC,,BOTH,1,EA,16.73,15.06,15.89,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.05,,,13.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,13.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,8.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,13.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.2,,,8.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.06,,,16.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.3,,,13.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.28,,,13.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.39,,,15.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.2,,,8.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.22,,,14.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.89,,,15.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,15.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.2,,,8.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.05,16.06,
DOXYCYCLINE MONOHYDRATE CAP 100 MG,Rx00000006676,CDM,,,250,RC,00000-0066-76,NDC,,BOTH,100,ME,16.76,15.08,15.92,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,13.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,8.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,13.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.21,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.09,,,16.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.32,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.29,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.42,,,15.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.21,,,8.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.25,,,14.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,15.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,15.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.21,,,8.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.07,16.09,
ERYTHROMYCIN TAB 250 MG,Rx69238148403,CDM,,,250,RC,69238-1484-03,NDC,,BOTH,250,ME,16.8,15.13,15.96,,,15.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.1,,,13.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.23,,,8.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.13,,,16.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.35,,,12.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.23,,,8.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.28,,,14.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.96,,,15.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.23,,,8.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.1,16.13,
PENICILLIN V POTASSIUM 500 MG (ED PREPACK-OR) PO TABS,Rx00000005845,CDM,,,250,RC,00000-0058-45,NDC,,BOTH,500,ME,16.81,15.13,15.97,,,15.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.11,,,13.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,8.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.14,,,16.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.36,,,13.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.32,,,13.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,15.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.29,,,14.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.97,,,15.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.11,16.14,
HC TED HOSE THIGH LENGTH SM REG,Sx000003130LF,CDM,,,270,RC,,,,BOTH,,,16.82,15.14,15.98,,,15.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.12,,,13.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,14.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,8.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,14.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.15,,,16.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.36,,,13.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.32,,,13.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,15.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,15.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.24,,,8.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.12,16.15,
LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV),Rx00093414845,CDM,J7614,HCPCS,636,RC,93414845,NDC,,BOTH,3,ML,16.84,15.16,16,,,16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.14,,,13.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,,,8.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.17,,,16.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.38,,,12.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,,,8.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.49,,,15.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,,,8.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.31,,,14.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.16,,,15.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.25,,,8.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.14,16.17,
HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM,Px00098110645,CDM,69209,CPT,981,RC,,,,OUTPATIENT,,,65,58.5,36.4,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.46,,,50.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,104.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,104.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.71,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.78,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.75,,,65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,50.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,59.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.1,,,33.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,55.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.4,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,61.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,46.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,46.7,16.2,
HC SLING ARM UNIV LARGE MESH W/WIDE STRAP SPECIALTY,Sx00079-84007,CDM,,,270,RC,,,,BOTH,,,16.92,15.23,16.07,,,15.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.2,,,13.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.23,,,14.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.23,,,8.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.23,,,14.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.29,,,8.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.23,,,15.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.24,,,16.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.44,,,13.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.37,,,13.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.57,,,15.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.29,,,8.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.38,,,14.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,15.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.23,,,16.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.29,,,8.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.2,16.24,
HC ALLEVYN ADH DRESSOMG 5X5,Px00005204WNH,CDM,,,270,RC,,,,BOTH,,,16.94,15.25,16.09,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.21,,,13.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,14.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,8.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,14.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.3,,,8.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,16.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.45,,,13.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.38,,,13.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.58,,,15.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.3,,,8.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.4,,,14.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.09,,,15.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.25,,,16.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.3,,,8.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.21,16.26,
PRAZOSIN HCL CAP 1 MG,Rx51079063001,CDM,,,250,RC,51079-0630-01,NDC,,BOTH,1,ME,16.95,15.26,16.1,,,16.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.22,,,13.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.27,,,16.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.46,,,12.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.39,,,8.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.59,,,15.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.41,,,14.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.1,,,16.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.22,16.27,
VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT),Rx68180016611,CDM,,,250,RC,68180-0166-11,NDC,,BOTH,125,ME,16.96,15.26,16.11,,,16.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,,,13.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.28,,,16.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.47,,,12.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.39,,,8.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.42,,,14.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.11,,,16.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.26,,,15.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,16.28,
METOCLOPRAMIDE HCL 10 MG (ED PREPACK-OR) PO TABS,Rx00000005844,CDM,,,250,RC,00000-0058-44,NDC,,BOTH,10,ME,16.96,15.26,16.11,,,15.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,14.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,8.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,14.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,15.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.28,,,16.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.47,,,13.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.39,,,13.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,15.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.42,,,14.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.11,,,15.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.26,,,16.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.31,,,8.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,16.28,
LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV),Rx76204090011,CDM,J7614,HCPCS,636,RC,76204090011,NDC,,BOTH,3,ML,16.97,15.27,16.12,,,16.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.24,,,13.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.32,,,8.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.29,,,16.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.47,,,12.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.32,,,8.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.61,,,15.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.32,,,8.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.42,,,14.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.12,,,16.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.27,,,15.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.32,,,8.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.24,16.29,
HC CAPILLARY BLOOD DRAW,Px00030010011,CDM,36416,CPT,300,RC,,,,BOTH,,,17,15.3,16.15,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.26,,,13.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,14.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,8.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,14.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.33,,,8.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.5,,,13.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.41,,,13.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.64,,,15.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.33,,,8.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.15,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,16.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.33,,,8.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.26,16.32,
MAGNESIUM HYDROXIDE SUSP 400 MG/5ML,Rx66689005301,CDM,,,250,RC,66689-0053-01,NDC,,BOTH,5,ML,17.1,15.39,16.25,,,16.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.34,,,13.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.39,,,15.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.39,,,15.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.39,,,15.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.38,,,8.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.39,,,15.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.42,,,16.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.57,,,12.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.46,,,8.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.73,,,15.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.38,,,8.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.54,,,14.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.25,,,16.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.39,,,15.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.38,,,8.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.34,16.42,
LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV),Rx76204090001,CDM,J7614,HCPCS,636,RC,76204090001,NDC,,BOTH,3,ML,17.18,15.46,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.49,,,16.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.63,,,12.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.81,,,15.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,16.49,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx00574012004,CDM,,,250,RC,00574-0120-04,NDC,,BOTH,1,EA,17.18,15.46,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.49,,,16.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.63,,,12.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,,,8.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.81,,,15.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,16.49,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx00574012074,CDM,,,250,RC,00574-0120-74,NDC,,BOTH,1,EA,17.18,15.46,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.49,,,16.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.63,,,12.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,,,8.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.81,,,15.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,16.49,
CHARCOAL ACTIVATED LIQ,Rx00574012104,CDM,,,250,RC,00574-0121-04,NDC,,BOTH,1,EA,17.18,15.46,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,,,13.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.49,,,16.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.63,,,12.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.5,,,8.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.81,,,15.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.6,,,14.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.32,,,16.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.42,,,8.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.4,16.49,
HC CLIPS LIGATING 6 CLIPS PER CARTRIDGE MD/LG,Sx000000LT300,CDM,,,270,RC,,,,BOTH,,,17.23,15.7,16.37,,,15.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.44,,,13.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.51,,,14.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.51,,,8.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.51,,,14.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.44,,,8.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.51,,,15.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.54,,,16.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.53,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.85,,,16.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.44,,,8.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.65,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.37,,,15.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.51,,,16.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.44,,,8.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.44,16.54,
AZITHROMYCIN FOR SUSP 200 MG/5ML,Rx00093202623,CDM,,,250,RC,00093-2026-23,NDC,,BOTH,5,ML,17.24,15.53,16.38,,,13.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.45,,,11.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,12.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,7.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,12.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.45,,,7.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,13.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.55,,,14.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.67,,,11.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.53,,,11.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.86,,,13.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.45,,,7.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.65,,,12.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.38,,,13.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,14.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.45,,,8.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.45,16.55,
HC DRESSING TEGADERM 4X4 FOAM NON ADHESIVE,Sx00000090601,CDM,,,270,RC,,,,BOTH,,,17.33,15.96,16.46,,,15.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,13.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,14.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,8.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,14.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,15.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,16.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.74,,,13.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.58,,,13.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.94,,,15.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.73,,,14.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,15.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,16.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.52,16.64,
METHOCARBAMOL 750 MG (ED PREPACK-OR) PO TABS,Rx00000005843,CDM,,,250,RC,00000-0058-43,NDC,,BOTH,750,ME,17.33,15.6,16.46,,,15.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.52,,,13.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,14.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,8.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,14.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,15.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,16.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.74,,,13.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.58,,,13.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.94,,,15.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.73,,,14.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,15.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,16.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.49,,,8.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.52,16.64,
PHENAZOPYRIDINE HCL 100 MG (ED PREPACK-OR) PO TABS,Rx00000005846,CDM,,,250,RC,00000-0058-46,NDC,,BOTH,100,ME,17.42,15.68,16.55,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.59,,,13.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,14.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,8.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,14.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.72,,,16.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.8,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.62,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.03,,,16.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.81,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.55,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.59,16.72,
HC TEGADERM SILICONE FOAM 4X4,Px00013049WNH,CDM,,,270,RC,,,,BOTH,,,17.43,15.69,16.56,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.6,,,13.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,14.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,8.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,14.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.73,,,16.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.81,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.63,,,13.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.04,,,16.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.82,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.56,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,16.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.54,,,8.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.6,16.73,
OFLOXACIN OTIC SOLN 0.3%,Rx69238161503,CDM,,,250,RC,69238-1615-03,NDC,,BOTH,1,EA,17.46,15.72,16.59,,,16.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.62,,,13.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.71,,,15.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.71,,,15.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.71,,,15.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.56,,,8.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.71,,,15.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.76,,,16.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.83,,,12.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.64,,,8.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.06,,,16.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.56,,,8.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.84,,,14.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.59,,,16.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.71,,,15.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.56,,,8.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.62,16.76,
BRIMONIDINE TARTRATE OPHTH SOLN 0.2%,Rx24208041105,CDM,,,250,RC,24208-0411-05,NDC,,BOTH,1,EA,17.5,15.75,16.63,,,16.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.65,,,13.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.75,,,15.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.75,,,15.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.75,,,15.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.58,,,8.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.75,,,15.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.8,,,16.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.86,,,12.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.66,,,8.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.1,,,16.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.58,,,8.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.88,,,14.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.63,,,16.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.75,,,15.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.58,,,8.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.65,16.8,
WARFARIN SODIUM TAB 1 MG,Rx00056016990,CDM,,,250,RC,00056-0169-90,NDC,,BOTH,1,ME,17.58,15.82,16.7,,,16.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.71,,,13.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.82,,,15.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.82,,,15.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.82,,,15.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.61,,,8.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.82,,,15.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.88,,,16.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.92,,,12.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.7,,,8.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.17,,,16.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.61,,,8.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.94,,,14.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.7,,,16.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.82,,,15.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.61,,,8.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.71,16.88,
ZIPRASIDONE HCL CAP 20 MG,Rx00904626908,CDM,,,250,RC,00904-6269-08,NDC,,BOTH,20,ME,17.61,15.82,16.73,,,16.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.74,,,13.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.85,,,15.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.85,,,15.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.85,,,15.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.63,,,8.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.85,,,15.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.91,,,16.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.94,,,12.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8.72,,,8.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.2,,,16.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.63,,,8.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.97,,,14.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.73,,,16.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.85,,,15.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.63,,,8.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.74,16.91,
ZIPRASIDONE HCL CAP 20 MG,Rx00904626945,CDM,,,250,RC,00904-6269-45,NDC,,BOTH,20,ME,17.75,15.94,16.86,,,15.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.85,,,13.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,9.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,9.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,15.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.04,,,17.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.05,,,13.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.78,,,13.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,16.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,9.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.09,,,15.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.86,,,15.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,16.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.7,,,8.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.85,17.04,
HC TED STOCKINGS ANTI-EMBOLI MED,Px00001262WNH,CDM,,,270,RC,,,,BOTH,,,17.78,16,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.87,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,9.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.36,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,8.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.87,17.07,
HC TED STOCKINGS ANTI-EMBOLI LG,Px00001263WNH,CDM,,,270,RC,,,,BOTH,,,17.78,16,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.87,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,9.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.36,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,8.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.87,17.07,
HC TED STOCKINGS ANTI-EMBOLI XLG,Px00001264WNH,CDM,,,270,RC,,,,BOTH,,,17.78,16,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.87,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,9.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.36,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,8.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.87,17.07,
HC TED STOCKINGS ANTI-EMBOLI MED LONG,Px00001265WNH,CDM,,,270,RC,,,,BOTH,,,17.78,16,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.87,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,9.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.36,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,8.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.87,17.07,
HC STOCKING TED HOSE XL LONG KNEE HIGH,Px00001267WNH,CDM,,,270,RC,,,,BOTH,,,17.78,16,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.87,,,13.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,9.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.07,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.36,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,9.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.11,,,15.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.89,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16,,,16.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.71,,,8.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.87,17.07,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx00574052074,CDM,,,250,RC,00574-0520-74,NDC,,BOTH,1,EA,17.79,16.01,16.9,,,16.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.88,,,13.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.01,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.01,,,9.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.01,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,9.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.01,,,16.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.08,,,17.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.08,,,13.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.8,,,13.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.37,,,16.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,9.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.12,,,15.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.9,,,16.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.01,,,16.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.72,,,8.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.88,17.08,
URSODIOL TAB 250 MG,Rx60687052711,CDM,,,250,RC,60687-0527-11,NDC,,BOTH,250,ME,17.85,16.07,16.96,,,16.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.92,,,13.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,14.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,9.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,14.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.75,,,9.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,16.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.14,,,17.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.12,,,13.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.83,,,13.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.42,,,16.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.75,,,9.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.17,,,15.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.96,,,16.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,16.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.75,,,8.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.92,17.14,
HC DRESSING TEGASORB 4X4,Px00008816WNH,CDM,,,270,RC,,,,BOTH,,,17.99,16.19,17.09,,,16.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.03,,,14.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,9.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,16.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.27,,,17.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.22,,,14.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.9,,,14.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.55,,,16.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.29,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.09,,,16.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,17.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.03,17.27,
HC BLOOD COUNT HEMOGLOBIN #,Px00030500138,CDM,85018,CPT,300,RC,,,,BOTH,,,18,16.2,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.04,,,14.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,9.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.28,,,17.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.91,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.04,17.28,
HC HEMOGLOBIN (HGB),Px00030015080,CDM,85018,CPT,300,RC,,,,BOTH,,,18,16.2,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.04,,,14.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,9.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.28,,,17.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.91,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.04,17.28,
HC HEMOGLOBIN POCT,Px00030015086,CDM,85018,CPT,300,RC,,,,BOTH,,,18,16.2,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.04,,,14.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,9.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,14.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.28,,,17.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.91,,,14.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,9.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,16.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.2,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.82,,,8.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.04,17.28,
FERRIC SUBSULFATE SOLN 259 MG/GM,Rx59365606501,CDM,,,250,RC,59365-6065-01,NDC,,BOTH,1,ME,18.22,16.41,17.31,,,17.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,,,14.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.93,,,8.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.49,,,17.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.39,,,13.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.02,,,9.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.76,,,16.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.93,,,8.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.49,,,15.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.31,,,17.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,8.93,,,8.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.21,17.49,
FERRIC SUBSULFATE SOLN 259 MG/GM,Rx59365606500,CDM,,,250,RC,59365-6065-00,NDC,,BOTH,1,ME,18.23,16.41,17.32,,,16.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.22,,,14.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,15.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,9.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,15.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.93,,,9.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,16.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.5,,,17.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.4,,,14.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.02,,,14.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.77,,,16.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.93,,,9.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.5,,,15.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.32,,,16.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8.93,,,8.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.22,17.5,
CHARCOAL ACTIVATED LIQ,Rx00574052174,CDM,,,250,RC,00574-0521-74,NDC,,BOTH,1,EA,18.4,16.01,17.48,,,17.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.35,,,14.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.02,,,9.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.52,,,13.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.11,,,9.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.93,,,16.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.02,,,9.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.64,,,15.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.48,,,17.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.56,,,16.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.02,,,9.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.35,17.66,
PROCHLORPERAZINE SUPPOS 25 MG,Rx00713013506,CDM,,,250,RC,00713-0135-06,NDC,,BOTH,25,ME,18.52,16.67,17.59,,,19.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,16.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.67,,,17.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.67,,,10.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.67,,,17.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.07,,,10.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.67,,,19.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.78,,,20.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.61,,,16.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.17,,,16.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.04,,,19.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.07,,,10.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.74,,,18.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.59,,,19.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.67,,,20.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.07,,,9.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.45,17.78,
HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED PREPACK-OR) PO TABS,Rx00000005895,CDM,,,250,RC,00000-0058-95,NDC,,BOTH,1,EA,18.81,16.93,17.87,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.67,,,14.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.93,,,15.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.93,,,9.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.93,,,15.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.22,,,9.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.93,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.06,,,18.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.83,,,14.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,14.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.31,,,17.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.22,,,9.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.99,,,16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.87,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.93,,,17.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.22,,,9.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.67,18.06,
HC RBC SED RATE AUTOMATED,Px00030510076,CDM,85652,CPT,300,RC,,,,BOTH,,,19,17.1,18.05,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.82,,,14.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,15.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,9.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,15.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.24,,,18.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.97,,,14.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.4,,,14.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.48,,,17.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.15,,,16.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.05,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,18.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.82,18.24,
CEPHALEXIN CAP 500 MG,Rx00000005892,CDM,,,250,RC,00000-0058-92,NDC,,BOTH,500,ME,19.01,17.11,18.06,,,17.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,14.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,15.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,9.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,15.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,17.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.25,,,18.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.97,,,14.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.41,,,14.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.49,,,17.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.16,,,16.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.06,,,17.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,18.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.31,,,9.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,14.83,18.25,
HC DRAPE 1015 SURG ORTHO 47X51 IN U-SHP STERL ADH IMPERV 3M,Sx00000001015,CDM,,,270,RC,,,,BOTH,,,19.3,17.37,18.34,,,17.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.05,,,15.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.37,,,16.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.37,,,9.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.37,,,16.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.46,,,9.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.37,,,17.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.53,,,18.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.19,,,15.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.55,,,15.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.76,,,17.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.46,,,9.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,16.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.34,,,17.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.37,,,18.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.46,,,9.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.05,18.53,
SALINE NASAL SPRAY 0.65%,Rx87701040085,CDM,,,250,RC,87701-0400-85,NDC,,BOTH,1,EA,19.38,17.44,18.41,,,18.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,,,15.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.44,,,17.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.44,,,17.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.44,,,17.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.5,,,9.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.44,,,17.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.6,,,18.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.24,,,14.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.59,,,9.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.83,,,17.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.5,,,9.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.47,,,16.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.41,,,18.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.44,,,17.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.5,,,9.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.12,18.6,
PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT,Rx00032121201,CDM,,,250,RC,00032-1212-01,NDC,,BOTH,1,EA,19.5,17.39,18.53,,,18.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.21,,,15.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.55,,,17.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.55,,,17.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.55,,,17.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.55,,,17.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.72,,,18.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.33,,,14.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.65,,,9.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.94,,,17.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.58,,,16.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.53,,,18.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.55,,,17.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.21,18.72,
OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),Rx70710116506,CDM,,,250,RC,70710-1165-06,NDC,,BOTH,1,ML,19.52,17.57,18.54,,,18.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.23,,,15.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.57,,,17.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.57,,,17.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.57,,,17.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.57,,,17.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.74,,,18.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.35,,,14.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.66,,,9.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.96,,,17.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.59,,,16.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.54,,,18.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.57,,,17.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.56,,,9.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.23,18.74,
CHARCOAL ACTIVATED LIQ,Rx66689020108,CDM,,,250,RC,66689-0201-08,NDC,,BOTH,1,EA,19.62,16.56,18.64,,,18.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.3,,,15.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.61,,,9.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.84,,,18.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.42,,,14.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.71,,,9.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.05,,,18.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.61,,,9.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.68,,,16.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.64,,,18.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.66,,,17.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.61,,,9.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.3,18.84,
ARIPIPRAZOLE TAB 5 MG,Rx62332009830,CDM,,,250,RC,62332-0098-30,NDC,,BOTH,5,ME,19.84,17.86,18.85,,,18.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.48,,,15.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.86,,,17.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.86,,,17.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.86,,,17.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.86,,,17.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.05,,,19.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.58,,,14.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9.82,,,9.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.25,,,18.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.86,,,16.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.85,,,18.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.86,,,17.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.72,,,9.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.48,19.05,
QUETIAPINE FUMARATE TAB ER 24HR 150 MG,Rx00310028160,CDM,,,250,RC,00310-0281-60,NDC,,BOTH,150,ME,19.93,17.94,18.93,,,25.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.55,,,22.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,23.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,14.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,23.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,14.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,25.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.13,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.65,,,22.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.86,,,22.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.34,,,26.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,14.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.94,,,24.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.93,,,25.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,26.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.77,,,9.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.55,19.13,
HC BLOOD DRAW VENIPUNCTURE,Px00030010004,CDM,36415,CPT,300,RC,,,,BOTH,,,28,18,19,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.6,,,21.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18,,,23.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18,,,14.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18,,,23.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.8,,,14.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.2,,,26.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,21.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.9,,,21.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.4,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.8,,,14.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17,,,23.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18,,,26.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.8,,,13.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.6,19.2,
MIRABEGRON TAB ER 24 HR 25 MG,Rx00469260130,CDM,,,250,RC,00469-2601-30,NDC,,BOTH,25,ME,20.11,17.64,19.1,,,18.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.69,,,15.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,16.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,10.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,16.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,10.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,18.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.31,,,19.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,15.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9.95,,,15.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.5,,,18.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,10.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.09,,,17.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.1,,,18.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,19.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.85,,,9.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.69,19.31,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx66689020308,CDM,,,250,RC,66689-0203-08,NDC,,BOTH,1,EA,20.23,16.56,19.22,,,15.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.78,,,13.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.21,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.21,,,8.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.21,,,14.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.91,,,8.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.21,,,15.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.42,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.87,,,13.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.01,,,13.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.61,,,16.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.91,,,8.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.2,,,15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.22,,,15.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.21,,,16.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9.91,,,9.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.78,19.42,
SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,Rx10019055390,CDM,,,250,RC,10019-0553-90,NDC,,BOTH,1,ME,20.34,18.31,19.32,,,19.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.87,,,15.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.31,,,18.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.31,,,18.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.31,,,18.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.97,,,9.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.31,,,18.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.53,,,19.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.95,,,14.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.07,,,10.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.71,,,18.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.97,,,9.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.29,,,17.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.32,,,19.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.31,,,18.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,9.97,,,9.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.87,19.53,
PROMETHAZINE HCL 12.5 MG (ED PREPACK-OR) RE SUPP,Rx00000003048,CDM,,,250,RC,00000-0030-48,NDC,,BOTH,12.5,ME,20.49,18.44,19.47,,,18.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.98,,,15.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.44,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.44,,,10.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.44,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.04,,,10.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.44,,,18.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.67,,,19.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.06,,,15.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.14,,,15.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.85,,,18.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.04,,,10.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.42,,,17.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.47,,,18.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.44,,,19.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.04,,,10.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.98,19.67,
HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD #,Px00030100454,CDM,84155,CPT,300,RC,,,,BOTH,,,20.7,18.63,19.67,,,18.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.15,,,16.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.63,,,17.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.63,,,10.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.63,,,17.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.14,,,10.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.63,,,18.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.21,,,16.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.24,,,16.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.04,,,19.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.14,,,10.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.6,,,17.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.67,,,18.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.63,,,19.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.14,,,10.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.15,19.87,
OFLOXACIN OTIC SOLN 0.3%,Rx60505036301,CDM,,,250,RC,60505-0363-01,NDC,,BOTH,1,EA,20.82,18.17,19.78,,,18.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.24,,,15.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,16.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,10.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,16.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.2,,,10.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,18.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.99,,,19.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.3,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.3,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.15,,,18.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.2,,,10.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.7,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.78,,,18.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,19.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.2,,,10.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.24,19.99,
HC DRESSING ALLEVYN 5X5 CALCIUM ALGINATE,Sx00066020044,CDM,,,270,RC,,,,BOTH,,,20.9,18.81,19.86,,,18.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.3,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,17.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,10.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,17.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.24,,,10.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,18.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.06,,,20.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.36,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.23,,,19.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.24,,,10.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.77,,,17.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.86,,,18.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,19.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.24,,,10.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.3,20.06,
TOLTERODINE TARTRATE CAP ER 24HR 2 MG,Rx00904659204,CDM,,,250,RC,00904-6592-04,NDC,,BOTH,2,ME,20.95,18.76,19.9,,,18.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.34,,,16.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,17.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,10.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,17.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,10.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,18.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.11,,,20.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.4,,,16.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.37,,,16.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.27,,,19.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,10.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.81,,,17.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.9,,,18.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,19.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.27,,,10.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.34,20.11,
TOLTERODINE TARTRATE CAP ER 24HR 2 MG,Rx60687031911,CDM,,,250,RC,60687-0319-11,NDC,,BOTH,2,ME,21.03,18.93,19.98,,,19.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,,,16.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.93,,,18.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.93,,,18.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.93,,,18.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.3,,,10.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.93,,,18.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.19,,,20.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.46,,,15.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.41,,,10.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.35,,,19.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.3,,,10.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.88,,,17.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.98,,,19.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.93,,,18.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.3,,,10.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.4,20.19,
WOUND DRESSINGS - GEL,Rx09958003460,CDM,,,250,RC,09958-0034-60,NDC,,BOTH,1,EA,21.11,19,20.05,,,19.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.47,,,16.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19,,,17.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19,,,10.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19,,,17.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,10.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19,,,19.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.27,,,20.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,16.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.45,,,16.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.42,,,19.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,10.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,17.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.05,,,19.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19,,,20.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,10.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.47,20.27,
PROMETHAZINE-CODEINE 6.25-10 MG/5ML (ED PREPACK-OR) PO SYRP,Rx00000005985,CDM,,,250,RC,00000-0059-85,NDC,,BOTH,5,ML,21.24,19.12,20.18,,,24.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.57,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,22.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,13.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,22.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.41,,,13.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,24.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.39,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.61,,,20.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.51,,,20.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.54,,,24.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.41,,,13.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.05,,,22.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.18,,,24.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,25.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.41,,,10.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.57,20.39,
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%,Rx61314063136,CDM,,,250,RC,61314-0631-36,NDC,,BOTH,1,EA,21.26,18.86,20.2,,,20.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.58,,,16.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.13,,,19.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.13,,,19.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.13,,,19.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.42,,,10.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.13,,,19.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.41,,,20.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.63,,,15.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10.52,,,10.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.56,,,19.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.42,,,10.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.07,,,18.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.2,,,20.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.13,,,19.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,10.42,,,10.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.58,20.41,
HC SUCTION RESERVOIR 100CC JACKSON-PRATT SU130-1305,Sx0SU130-1305,CDM,,,270,RC,,,,BOTH,,,21.29,15.61,20.23,,,19.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,16.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.16,,,17.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.16,,,10.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.16,,,17.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.43,,,10.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.16,,,19.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.44,,,20.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.65,,,16.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.54,,,16.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.59,,,19.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.43,,,10.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.1,,,18.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.23,,,19.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.16,,,20.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.43,,,10.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.61,20.44,
CLINDAMYCIN HCL 300 MG (ED PREPACK-OR) PO CAPS,Rx00000005837,CDM,,,250,RC,00000-0058-37,NDC,,BOTH,300,ME,21.99,19.79,20.89,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.79,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.79,,,11.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.79,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.79,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.11,,,21.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.16,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.88,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.23,,,20.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.69,,,18.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.89,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.79,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,10.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.15,21.11,
HC DRESSING SILVER ACTISORB 220 2 1/2 X 3 3/4,Px00013202WNH,CDM,,,270,RC,,,,BOTH,,,22,19.8,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.16,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,11.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.12,,,21.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.89,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.24,,,20.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,18.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,10.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.16,21.12,
HC URINALYSIS VOLUME MEASURE,Px00030013017,CDM,81050,CPT,300,RC,,,,BOTH,,,22,19.8,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.16,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,11.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.12,,,21.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.89,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.24,,,20.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,18.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,10.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.16,21.12,
HC DECALCIFICATION PROCEDURE #,Px00031010341,CDM,88311,CPT,300,RC,,,,BOTH,,,22,19.8,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.16,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,11.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.12,,,21.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.89,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.24,,,20.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,18.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.9,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.78,,,10.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.16,21.12,
SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV),Rx00173052100,CDM,,,250,RC,00173-0521-00,NDC,,BOTH,0.05,ME,22.16,19.95,21.05,,,740.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.28,,,642.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.94,,,685.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.94,,,419.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.94,,,685.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,419.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.94,,,740.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.27,,,790.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,642.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.97,,,642.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.39,,,757.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,419.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.84,,,699.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.05,,,740.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.94,,,781.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10.86,,,10.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.28,21.27,
HC PR ED 36410 NON-ROUTINE BL DRAW > 3 YRS CDM,Px00098110592,CDM,36410,CPT,981,RC,,,,OUTPATIENT,,,38,34.2,21.28,,,34.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,29.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,31.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,19.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,31.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.05,,,19.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11.16,,,34.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.9,,,36.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,8.74,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8.74,,,29.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.66,,,34.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,9,,,19.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.66,,,32.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.28,,,34.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,36.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,8.74,,,8.74,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,8.74,21.6,
HC PR 36410 NON-ROUTINE BL DRAW > 3 YRS,Px00096310233,CDM,36410,CPT,963,RC,,,,BOTH,,,22,19.8,12.32,,,19.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,17.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,18.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,11.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,18.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,11.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11.16,,,19.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,12.83,,,21.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,17.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.26,,,20.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.45,,,11.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,12.54,,,18.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,12.32,,,19.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,20.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.34,,,10.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,10.34,21.6,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx69315030615,CDM,,,250,RC,69315-0306-15,NDC,,BOTH,1,GR,22.57,20.35,21.44,,,20.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.6,,,17.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.31,,,18.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.31,,,11.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.31,,,18.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,11.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.31,,,20.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.67,,,21.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.59,,,17.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.17,,,17.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.76,,,20.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,11.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.18,,,19.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.44,,,20.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.31,,,21.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.06,,,11.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.6,21.67,
HC DRAPE STERI IRR POUCH,Sx00000001016,CDM,,,270,RC,,,,BOTH,,,22.79,20.51,21.65,,,20.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.78,,,17.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.51,,,18.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.51,,,11.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.51,,,18.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.17,,,11.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.51,,,20.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.88,,,21.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.75,,,17.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.28,,,17.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.97,,,20.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.17,,,11.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.37,,,19.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.65,,,20.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.51,,,21.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.17,,,11.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.78,21.88,
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%,Rx61314063006,CDM,,,250,RC,61314-0630-06,NDC,,BOTH,1,EA,22.84,20.56,21.7,,,21.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.82,,,17.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.19,,,11.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.93,,,21.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.79,,,16.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.3,,,11.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.01,,,21.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.19,,,11.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.41,,,19.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.7,,,21.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.19,,,11.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.82,21.93,
NYSTATIN TOPICAL POWDER 100000 UNIT/GM,Rx00574200815,CDM,,,250,RC,00574-2008-15,NDC,,BOTH,1,GR,22.91,20.62,21.76,,,21.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.87,,,17.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.62,,,20.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.62,,,20.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.62,,,20.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.23,,,11.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.62,,,20.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.99,,,21.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.84,,,16.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.34,,,11.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.08,,,21.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.23,,,11.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.47,,,19.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.76,,,21.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.62,,,20.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.23,,,11.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.87,21.99,
HYDROCORTISONE CREAM 1%,Rx00168001531,CDM,,,250,RC,00168-0015-31,NDC,,BOTH,1,EA,22.96,27.69,21.81,,,21.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.91,,,17.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.66,,,20.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.66,,,20.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.66,,,20.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.25,,,11.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.66,,,20.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.04,,,22.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,16.88,,,16.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.36,,,11.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.12,,,21.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.25,,,11.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.52,,,19.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.81,,,21.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.66,,,20.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.25,,,11.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.91,22.04,
HC APPL MODALITY 1/> AREAS PARAFFIN BATH,Px00043010004,CDM,97018,CPT,430,RC,,,,BOTH,,,23,20.7,21.85,,,20.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.94,,,17.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,19.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,11.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,19.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.27,,,11.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,20.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,22.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.91,,,17.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.38,,,17.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.16,,,21.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.27,,,11.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,19.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.85,,,20.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,21.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.27,,,11.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,17.94,22.08,
BENZOCAINE-BENZETHONIUM AEROSOL 20-0.2%,Rx51409000724,CDM,,,250,RC,51409-0007-24,NDC,,BOTH,1,EA,23.16,20.84,22,,,20.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.06,,,18.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.84,,,19.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.84,,,11.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.84,,,19.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.35,,,11.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.84,,,20.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.23,,,22.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.02,,,18.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.46,,,18.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.31,,,21.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.35,,,11.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.69,,,19.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22,,,20.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.84,,,22.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.35,,,11.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.06,22.23,
CLOBETASOL PROPIONATE CREAM 0.05%,Rx51672125802,CDM,,,250,RC,51672-1258-02,NDC,,BOTH,1,EA,23.27,20.98,22.11,,,22.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.15,,,18.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.94,,,20.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.94,,,20.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.94,,,20.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.4,,,11.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.94,,,20.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.34,,,22.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.1,,,17.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.52,,,11.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.41,,,21.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.4,,,11.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.78,,,19.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.11,,,22.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.94,,,20.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.4,,,11.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.15,22.34,
NYSTATIN CREAM 100000 UNIT/GM,Rx00713067831,CDM,,,250,RC,00713-0678-31,NDC,,BOTH,1,GR,23.27,20.94,22.11,,,20.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.15,,,18.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.94,,,19.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.94,,,11.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.94,,,19.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.4,,,11.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.94,,,20.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.34,,,22.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.1,,,18.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.52,,,18.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.41,,,21.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.4,,,11.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.78,,,19.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.11,,,20.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.94,,,22.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.4,,,11.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.15,22.34,
HC PR 01968 ANES/ANALG CS DELIVER ADD-ON,Px00096310200,CDM,1968,CPT,963,RC,,,,BOTH,,,34.4,30.96,19.26,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.23,,,31.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.5,,,33.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.5,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.5,,,33.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.92,,,38.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.58,,,31.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,31.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.61,,,36.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.34,,,20.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.61,,,34.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.26,,,36.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.36,,,38.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,16.17,22.36,BASE FEE
HC NIPPLE SHIELD CONTACT NEWBORN,Px00002692WNH,CDM,,,270,RC,,,,BOTH,,,23.59,21.23,22.41,,,21.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.4,,,18.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,19.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,12.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,19.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.56,,,12.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,21.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.65,,,22.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.34,,,18.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.67,,,18.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.7,,,21.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.56,,,12.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.05,,,20.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.41,,,21.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,22.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.56,,,11.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.4,22.65,
SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV),Rx00173052000,CDM,,,250,RC,00173-0520-00,NDC,,BOTH,0.05,ME,23.65,21.29,22.47,,,22.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.45,,,18.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.29,,,21.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.29,,,21.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.29,,,21.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.59,,,11.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.29,,,21.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.7,,,22.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.38,,,17.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.7,,,11.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.76,,,21.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.59,,,11.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.1,,,20.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.47,,,22.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.29,,,21.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.59,,,11.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.45,22.7,
HC CREAM SKIN 4 OZ.,Px00009111WNH,CDM,,,270,RC,,,,BOTH,,,23.73,21.36,22.54,,,21.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.51,,,18.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,19.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,12.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,19.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,21.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.78,,,22.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.44,,,18.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.74,,,18.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.83,,,21.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.17,,,20.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,21.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,22.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.51,22.78,
HC WIRE KIRSCHNER .062 IN SMOOTH 9 IN LONG W DIAMOND POINT,Sx00018600379,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,23.73,21.36,22.54,,,21.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.51,,,18.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,19.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,12.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,19.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,21.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.78,,,22.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.44,,,18.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.74,,,18.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.83,,,21.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,12.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.17,,,20.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,21.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.36,,,22.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.63,,,11.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.51,22.78,
CHARCOAL ACTIVATED LIQ,Rx00574012176,CDM,,,250,RC,00574-0121-76,NDC,,BOTH,1,EA,23.89,21.5,22.7,,,22.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.63,,,18.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.5,,,21.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.5,,,21.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.5,,,21.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.71,,,11.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.5,,,21.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.93,,,22.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,17.56,,,17.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11.82,,,11.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.98,,,21.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.71,,,11.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.31,,,20.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.7,,,22.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.5,,,21.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,11.71,,,11.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.63,22.93,
HC TED HOSE THIGH LENGTH XXL REG,Sx000003184LF,CDM,,,270,RC,,,,BOTH,,,23.92,21.53,22.72,,,21.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.66,,,18.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.53,,,19.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.53,,,12.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.53,,,19.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.72,,,12.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.53,,,21.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.96,,,22.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.58,,,18.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.84,,,18.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.01,,,22.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.72,,,12.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.33,,,20.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.72,,,21.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.53,,,22.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.72,,,11.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.66,22.96,
HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL #,Px00030200133,CDM,86592,CPT,300,RC,,,,BOTH,,,24,21.6,22.8,,,21.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.72,,,18.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,19.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,12.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,19.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,12.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,21.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.04,,,23.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,18.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,22.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,12.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.4,,,20.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.8,,,21.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,22.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,11.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.72,23.04,
HC INFRARED THERAPY,Px00042010121,CDM,97026,CPT,420,RC,,,,BOTH,,,80,21.6,22.8,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.72,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,66.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,40.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,66.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,40.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.04,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.88,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,40.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.4,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.8,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.6,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.76,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.72,23.04,
HC COLLAR CERVICAL LG FORM FIT MED DENISTY,Sx00000083007,CDM,L0120,HCPCS,274,RC,,,,BOTH,,,24.14,21.73,22.93,,,21.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.83,,,18.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,20.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,12.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,20.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.83,,,12.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,21.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.17,,,23.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.74,,,18.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.95,,,18.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.21,,,22.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.83,,,12.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.52,,,20.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.93,,,21.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,22.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.83,,,11.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.83,23.17,
CHARCOAL ACTIVATED-SORBITOL SUSP,Rx66689020304,CDM,,,250,RC,66689-0203-04,NDC,,BOTH,1,EA,24.19,23.55,22.98,,,21.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.87,,,18.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,20.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,12.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,20.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.85,,,12.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,21.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.22,,,23.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.78,,,18.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11.97,,,18.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.25,,,22.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.85,,,12.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.56,,,20.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.98,,,21.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,22.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.85,,,11.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.87,23.22,
HC PR 59025 FETAL NON-STRESS TEST,Px00096910601,CDM,59025,CPT,983,RC,,,,BOTH,,,69,62.1,38.64,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.13,,,53.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,54.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,23.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,54.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,23.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.33,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.95,,,66.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.14,,,53.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.14,,,53.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.33,,,63.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.53,,,23.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.33,,,58.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.4,,,65.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.14,,,125.14,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,125.14,23.4,
HC CREAM SKIN REPAIR REMEDY 4 OZ,Sx0MSC0924404,CDM,,,270,RC,,,,BOTH,,,24.42,21.98,23.2,,,21.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.05,,,19.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.98,,,20.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.98,,,12.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.98,,,20.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.97,,,12.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.98,,,21.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.44,,,23.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.95,,,19.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.09,,,19.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.47,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.97,,,12.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.76,,,20.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,21.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.98,,,23.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.97,,,11.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.05,23.44,
TIOTROPIUM BROMIDE MONOHYDRATE INHAL CAP 18 MCG (BASE EQUIV),Rx00597007575,CDM,,,250,RC,00597-0075-75,NDC,,BOTH,0.018,ME,24.44,22.01,23.22,,,83.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.06,,,72.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22,,,77.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22,,,47.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22,,,77.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,47.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22,,,83.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.46,,,88.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.96,,,72.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.1,,,72.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.48,,,85.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,47.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.77,,,78.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.22,,,83.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22,,,88.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11.98,,,11.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.06,23.46,
HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM,Px00045010864,CDM,36415,CPT,450,RC,,,,OUTPATIENT,,,25,18,23.75,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.5,,,17.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,11.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,18.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24,,,21.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.38,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.37,,,17.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23,,,20.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,11.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.25,,,18.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,19.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.5,24,
HC MICROSCOPIC EXAM OF URINE,Px00030710010,CDM,81015,CPT,300,RC,,,,BOTH,,,25,22.5,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.5,,,19.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,12.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24,,,24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.38,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.37,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23,,,23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.25,,,21.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,23.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.5,24,
HC BLOOD TYPING SEROLOGIC RH (D) #,Px00030200566,CDM,86901,CPT,300,RC,,,,BOTH,,,25,22.5,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.5,,,19.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,12.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24,,,24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.38,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.37,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23,,,23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.25,,,21.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,23.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.5,24,
HC BLOOD TYPING SEROLOGIC RH (D) #,Px00030200567,CDM,86901,CPT,300,RC,,,,BOTH,,,25,22.5,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.5,,,19.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,12.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,20.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24,,,24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.38,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.37,,,19.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23,,,23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.25,,,21.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,22.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,23.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.25,,,12.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.5,24,
RIFAXIMIN TAB 550 MG,Rx65649030303,CDM,,,250,RC,65649-0303-03,NDC,,BOTH,550,ME,25.3,22.1,24.04,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.73,,,51.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,54.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,33.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,54.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.4,,,33.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,59.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.29,,,63.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.6,,,51.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.52,,,51.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.28,,,60.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.4,,,33.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.51,,,55.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.04,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,62.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.4,,,12.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.73,24.29,
HC PR ED 29550 STRAPPING OF TOES CDM,Px00098110625,CDM,29550,CPT,981,RC,,,,OUTPATIENT,,,46,41.4,25.76,,,41.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,35.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.75,,,38.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.75,,,23.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.75,,,38.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,12.28,,,23.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.65,,,41.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.3,,,44.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.68,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10.68,,,35.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.22,,,42.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,11,,,23.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.22,,,39.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.76,,,41.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.29,,,43.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,10.68,,,10.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,10.68,24.29,
METHYLERGONOVINE MALEATE TAB 0.2 MG,Rx00093365528,CDM,,,250,RC,00093-3655-28,NDC,,BOTH,0.2,ME,25.55,23,24.27,,,23.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.93,,,19.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23,,,21.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23,,,13.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23,,,21.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.52,,,13.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23,,,23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.53,,,24.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.78,,,19.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.64,,,19.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.51,,,23.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.52,,,13.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.72,,,21.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.27,,,23.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23,,,24.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.52,,,12.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.93,24.53,
"HC GRIPPER PLUS 1"" PORT-A-CATH",Px00007372WNH,CDM,,,270,RC,,,,BOTH,,,25.62,23.06,24.34,,,23.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.98,,,19.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.06,,,21.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.06,,,13.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.06,,,21.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.55,,,13.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.06,,,23.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.6,,,24.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.83,,,19.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.68,,,19.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.57,,,23.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.55,,,13.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.78,,,21.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.34,,,23.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.06,,,24.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.55,,,12.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.98,24.6,
HC DRESSING UNNA-FLX 3 IN 3 IN X 10 YDS,Sx00000008033,CDM,,,270,RC,,,,BOTH,,,25.63,23.07,24.35,,,23.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.99,,,20,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.07,,,21.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.07,,,13.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.07,,,21.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.56,,,13.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.07,,,23.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.6,,,24.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.84,,,20,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.68,,,20,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.58,,,23.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.56,,,13.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.79,,,21.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.35,,,23.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.07,,,24.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.56,,,12.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.99,24.6,
HC DRESSING SILVER ACTISORB 220 2 1/2X3 3/4,Sx00000650220,CDM,,,270,RC,,,,BOTH,,,25.66,23.63,24.38,,,23.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.01,,,20.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.09,,,21.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.09,,,13.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.09,,,21.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.57,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.09,,,23.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.63,,,24.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.86,,,20.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.7,,,20.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.61,,,23.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.57,,,13.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.81,,,21.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.38,,,23.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.09,,,24.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.57,,,12.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.01,24.63,
SILVER SULFADIAZINE CREAM 1%,Rx43598021085,CDM,,,250,RC,43598-0210-85,NDC,,BOTH,1,EA,25.8,21.76,24.51,,,24.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.12,,,20.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.22,,,23.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.22,,,23.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.22,,,23.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.64,,,12.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.22,,,23.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.77,,,24.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.96,,,18.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.77,,,12.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.74,,,23.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.64,,,12.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.93,,,21.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.51,,,24.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.22,,,23.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.64,,,12.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.12,24.77,
LIDOCAINE PATCH 5%,Rx63481068701,CDM,,,250,RC,63481-0687-01,NDC,,BOTH,1,EA,25.83,23.25,24.54,,,24.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.15,,,20.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.25,,,23.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.25,,,23.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.25,,,23.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.66,,,12.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.25,,,23.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.8,,,24.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.99,,,18.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12.78,,,12.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.76,,,23.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.66,,,12.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.96,,,21.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.54,,,24.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.25,,,23.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,12.66,,,12.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.15,24.8,
HC COLLECTOR FECAL FLEXI SEAL W/DRAIN,Sx00000650078,CDM,,,270,RC,,,,BOTH,,,25.84,23.26,24.55,,,23.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.16,,,20.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,21.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,13.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,21.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,13.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,23.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.81,,,24.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.99,,,20.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12.79,,,20.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.77,,,23.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,13.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.96,,,21.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,23.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,24.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12.66,,,12.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.16,24.81,
OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),Rx47781038426,CDM,,,250,RC,47781-0384-26,NDC,,BOTH,1,ML,26.91,24.22,25.56,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.99,,,21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.22,,,22.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.22,,,13.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.22,,,22.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.19,,,13.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.22,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.83,,,25.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.78,,,21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.32,,,21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.76,,,24.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.19,,,13.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.87,,,22.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.56,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.22,,,25.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.19,,,13.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.99,25.83,
HC SPONGE GELFOAM STERILE GELATIN,Px00000601WNH,CDM,,,270,RC,,,,BOTH,,,26.95,24.26,25.6,,,24.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.02,,,21.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,22.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,13.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,22.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.21,,,13.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,24.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.87,,,25.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.81,,,21.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.34,,,21.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.79,,,24.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.21,,,13.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.91,,,22.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,24.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.21,,,13.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.02,25.87,
HYDROCORTISONE CREAM 1%,Rx00472032126,CDM,,,250,RC,00472-0321-26,NDC,,BOTH,1,EA,26.99,24.29,25.64,,,25.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.05,,,21.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.29,,,24.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.29,,,24.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.29,,,24.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.29,,,24.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.91,,,25.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.84,,,19.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13.36,,,13.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.83,,,24.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.94,,,22.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.64,,,25.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.29,,,24.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.05,25.91,
HC URINALYSIS AUTO W/SCOPE,Px00030710009,CDM,81001,CPT,300,RC,,,,BOTH,,,27,24.3,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.06,,,21.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,13.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.92,,,25.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.85,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.36,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.84,,,24.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.95,,,22.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,25.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.06,25.92,
HC GLUCOSE BODY FLUID OTHER THAN BLOOD #,Px00030100765,CDM,82945,CPT,300,RC,,,,BOTH,,,27,24.3,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.06,,,21.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,13.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.92,,,25.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.85,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.36,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.84,,,24.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.95,,,22.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,25.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.06,25.92,
HC GLUCOSE BODY FLUID OTHER THAN BLOOD,Px00030014981,CDM,82945,CPT,300,RC,,,,BOTH,,,27,24.3,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.06,,,21.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,13.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,22.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.92,,,25.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.85,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.36,,,21.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.84,,,24.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.95,,,22.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.65,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.3,,,25.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.23,,,13.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.06,25.92,
ERYTHROMYCIN 5 MG/GM (ED PREPACK-OR) OP OINT,Rx00000003835,CDM,,,250,RC,00000-0038-35,NDC,,BOTH,1,GR,27.28,24.55,25.92,,,35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.28,,,30.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,32.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,19.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,32.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.37,,,19.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,34.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.19,,,37.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.05,,,30.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.5,,,30.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,35.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.37,,,19.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.19,,,33.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.92,,,35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.55,,,36.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.37,,,13.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.28,26.19,
PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM,Rx52268010001,CDM,,,250,RC,52268-0100-01,NDC,,BOTH,236,GR,27.65,24.89,26.27,,,24.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.57,,,21.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.89,,,23.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.89,,,14.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.89,,,23.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.55,,,14.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.89,,,24.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.54,,,26.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.32,,,21.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.68,,,21.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.44,,,25.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.55,,,14.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.5,,,23.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,24.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.89,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.55,,,13.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.57,26.54,
HC TEGEDERM SILICONE FOAM 6x6 DRESSING,Sx00000090642,CDM,,,270,RC,,,,BOTH,,,27.89,43.24,26.5,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.75,,,21.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,23.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,14.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,23.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.67,,,14.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,25.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.77,,,26.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.5,,,21.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.8,,,21.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.66,,,25.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.67,,,14.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.71,,,23.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.5,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.1,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.67,,,13.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.75,26.77,
HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP),Px00030014986,CDM,82947,CPT,300,RC,,,,BOTH,,,28,25.2,26.6,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.84,,,21.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.2,,,23.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.2,,,14.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.2,,,23.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.72,,,14.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.2,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.88,,,26.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.86,,,21.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.76,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.72,,,14.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.8,,,23.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.6,,,25.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.2,,,26.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.72,,,13.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.84,26.88,
HC MEDIHONEY DRESSING 2X2,Px00012214WNH,CDM,,,270,RC,,,,BOTH,,,28.07,25.26,26.67,,,25.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.89,,,21.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.26,,,23.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.26,,,14.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.26,,,23.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,14.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.26,,,25.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.63,,,21.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,21.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.82,,,25.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,14.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.86,,,23.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.67,,,25.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.26,,,26.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.75,,,13.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.89,26.95,
HC WAX BONE 2.5GM,Sx0000000W31G,CDM,,,270,RC,,,,BOTH,,,28.23,26.33,26.82,,,26.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.02,,,22.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.41,,,24.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.41,,,14.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.41,,,24.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.83,,,14.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.41,,,26.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.1,,,28.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.75,,,22.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.97,,,22.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,26.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.83,,,14.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24,,,24.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.82,,,26.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.41,,,27.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13.83,,,13.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.02,27.1,
HC DRAIN JACKSON-PRATT/10MM SILICONE FLAT DRAIN,Sx0SU130-1311,CDM,,,270,RC,,,,BOTH,,,28.73,22.93,27.29,,,25.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.41,,,22.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,23.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,14.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,23.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.08,,,14.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,25.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.58,,,27.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.12,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.22,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.43,,,26.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.08,,,14.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.42,,,24.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,25.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.08,,,14.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.41,27.58,
HC CAST BOOT SANDAL LG,Px00000239WNH,CDM,,,270,RC,,,,BOTH,,,29,26.1,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,22.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.32,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.35,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.68,,,26.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.65,,,24.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,27.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.62,27.84,
HC ASSAY URINE CREATININE,Px00030013840,CDM,82570,CPT,300,RC,,,,BOTH,,,29,26.1,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,22.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.32,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.35,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.68,,,26.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.65,,,24.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,27.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.62,27.84,
HC DIFFERENTIAL MANUAL,Px00030012071,CDM,85007,CPT,300,RC,,,,BOTH,,,29,26.1,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,22.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.32,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.35,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.68,,,26.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.65,,,24.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,27.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.62,27.84,
HC RBC SED RATE NONAUTOMATED,Px00030510027,CDM,85651,CPT,300,RC,,,,BOTH,,,29,26.1,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,22.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,14.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,24.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.32,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.35,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.68,,,26.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.65,,,24.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,27.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.62,27.84,
HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES #,Px00030610463,CDM,87147,CPT,300,RC,,,,BOTH,,,29,26.1,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,22.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,79.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,79.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.32,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.35,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.68,,,26.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.65,,,24.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.55,,,26.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.1,,,27.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.21,,,14.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.62,27.84,
HC SPLINT COLLES LEFT - MEDIUM,Px00000252WNH,CDM,,,270,RC,,,,BOTH,,,29.05,26.15,27.6,,,26.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.66,,,22.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,14.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,26.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.89,,,27.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.35,,,22.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.38,,,22.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.73,,,26.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.69,,,24.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.6,,,26.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,27.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.23,,,14.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.66,27.89,
HC SHOE POST OP MEN - MEDIUM,Px00001294WNH,CDM,,,270,RC,,,,BOTH,,,29.12,26.21,27.66,,,26.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.71,,,22.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,24.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,14.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,24.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,14.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,26.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.96,,,27.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.4,,,22.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.41,,,22.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.79,,,26.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,14.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,24.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.66,,,26.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,27.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.27,,,14.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.71,27.96,
ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV),Rx00054074287,CDM,,,250,RC,00054-0742-87,NDC,,BOTH,0.09,ME,29.16,14.13,27.7,,,125.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.74,,,109.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,71.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.29,,,71.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,125.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.99,,,134.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.43,,,109.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.43,,,109.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.29,,,71.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.79,,,118.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.7,,,125.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,132.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.29,,,14.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.74,27.99,
HC TEGADERM SLINCONE FOAM 6X6,Px00013050WNH,CDM,,,270,RC,,,,BOTH,,,29.19,26.27,27.73,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,22.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,14.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,24.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.02,,,28.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.45,,,22.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.45,,,22.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.85,,,26.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.81,,,24.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.73,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,27.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.3,,,14.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.77,28.02,
HC GAYMAR HEATING PAD 13X18,Px00002376WNH,CDM,,,270,RC,,,,BOTH,,,29.47,26.52,28,,,26.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.99,,,22.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,24.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,15.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,24.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,15.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.29,,,28.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.66,,,22.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.58,,,22.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,27.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,15.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.05,,,25.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28,,,26.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.44,,,14.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,22.99,28.29,
HC PR ED 43753 TX GASTRO INTUB W/ASP CDM,Px00098110375,CDM,43753,CPT,981,RC,,,,OUTPATIENT,,,91,81.9,50.96,,,81.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,70.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.88,,,75.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.88,,,46.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.88,,,75.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,46.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,81.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.05,,,87.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,70.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.87,,,83.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.77,,,46.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.87,,,77.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,81.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.35,,,86.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.24,28.35,
HC PROTECTANT SKIN NUTRASHIELD 0,Sx00MSC092544,CDM,,,270,RC,,,,BOTH,,,29.54,26.59,28.06,,,26.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.04,,,23.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,24.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,15.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,24.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,15.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,26.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.36,,,28.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.71,,,23.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.62,,,23.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.18,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,15.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.11,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.06,,,26.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,28.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.47,,,14.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.04,28.36,
HC COLLAR CERVICAL SMALL FORM FIT FIRM DENSITY,Sx00079-83003,CDM,L0120,HCPCS,274,RC,,,,BOTH,,,29.82,26.84,28.33,,,26.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,23.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,24.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,15.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,24.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,15.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,26.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.63,,,28.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.92,,,23.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.76,,,23.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,27.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,15.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.35,,,25.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.33,,,26.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,28.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.61,,,14.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.26,28.63,
HC DRESSING DUO DERM6X6 REGULAR CONTROL GEL FORMULA,Sx00000187661,CDM,,,270,RC,,,,BOTH,,,29.97,26.97,28.47,,,26.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.38,,,23.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.97,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.97,,,15.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.97,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.69,,,15.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.97,,,26.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.77,,,28.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.03,,,23.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.83,,,23.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.57,,,27.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.69,,,15.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.47,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.47,,,26.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.97,,,28.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.69,,,14.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.38,28.77,
HC PASTE CALAZIME 4OZ,Px00009109WNH,CDM,,,270,RC,,,,BOTH,,,30,27,28.5,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.4,,,23.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,15.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,23.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,23.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.6,,,27.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,15.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.5,,,25.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.5,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,28.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,14.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.4,28.8,
HC FECAL LEUKOCYTES,Px00030010281,CDM,89055,CPT,300,RC,,,,BOTH,,,30,27,28.5,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.4,,,23.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,15.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,15.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,23.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,23.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.6,,,27.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,15.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.5,,,25.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.5,,,27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27,,,28.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.7,,,14.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.4,28.8,
HC DRESSING MEPILEX 4X10 STERILE HCPCS A6212,Sx00000295850,CDM,,,270,RC,,,,BOTH,,,30.03,27.03,28.53,,,27.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.42,,,23.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,15.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,15.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,27.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.83,,,28.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.07,,,23.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,23.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.63,,,27.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,15.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.53,,,25.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.53,,,27.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,28.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.71,,,14.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.42,28.83,
HC DISPOSABLE SOUND DILATOR STERILE,Sx000DSD-1000,CDM,,,270,RC,,,,BOTH,,,30.09,27.08,28.59,,,27.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.47,,,23.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,25.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,15.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,25.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,15.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,27.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.12,,,23.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.89,,,23.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.68,,,27.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,15.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.58,,,25.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.59,,,27.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,28.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,14.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.47,28.89,
HC COVER PROBE INTRAOPERATIVE,Px00008888WNH,CDM,,,270,RC,,,,BOTH,,,30.12,27.11,28.61,,,27.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,23.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,25.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,15.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,25.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.76,,,15.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,27.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.92,,,28.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.14,,,23.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.91,,,23.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.71,,,27.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.76,,,15.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,25.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.61,,,27.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.11,,,28.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.76,,,14.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.49,28.92,
HC COLLAR CERVICAL MED FORM FIT FIRM DENISTY,Sx00079-83005,CDM,L0120,HCPCS,274,RC,,,,BOTH,,,30.16,27.14,28.65,,,27.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,23.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,27.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.95,,,28.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.17,,,23.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.93,,,23.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.75,,,27.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.64,,,25.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.65,,,27.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,28.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,14.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.52,28.95,
HC COLLAR CERVICAL M/L FORM FIT FIRM DENISTY,Sx00079-83006,CDM,L0120,HCPCS,274,RC,,,,BOTH,,,30.16,27.14,28.65,,,27.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,23.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,15.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,27.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.95,,,28.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.17,,,23.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.93,,,23.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.75,,,27.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,15.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.64,,,25.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.65,,,27.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,28.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.78,,,14.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.52,28.95,
HC INFUSION SET POWER LOC 1.0 IN 20GX1.0 IN OR .9MM X 25MM,Sx00000672010,CDM,,,270,RC,,,,BOTH,,,30.3,30.87,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.63,,,23.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.09,,,29.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.27,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.88,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.76,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,28.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,14.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.63,29.09,
HC INFUSION SET POWER LOC 0.75 IN 20G X .75,Sx00000672034,CDM,,,270,RC,,,,BOTH,,,30.3,30.87,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.63,,,23.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.09,,,29.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.27,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.88,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.76,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,28.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,14.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.63,29.09,
HC INFUSION SET POWER LOC 20G X 3/4,Sx00000652034,CDM,,,270,RC,,,,BOTH,,,30.3,30.87,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.63,,,23.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,15.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,25.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.09,,,29.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.27,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15,,,23.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.88,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,15.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.76,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.79,,,27.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.27,,,28.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.85,,,14.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.63,29.09,
NITROGLYCERIN 0.4 MG (ED PREPACK-OR) SL SUBL,Rx00000003115,CDM,,,250,RC,00000-0031-15,NDC,,BOTH,0.4,ME,30.32,27.29,28.8,,,27.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.65,,,23.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,25.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,15.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,25.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,15.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,27.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,29.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.29,,,23.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.01,,,23.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.89,,,27.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,15.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.77,,,25.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,27.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.86,,,14.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.65,29.11,
HC SOL IV DEX 5 PCT 100ML,Sx000002B0087,CDM,,,270,RC,,,,BOTH,,,30.36,11.4,28.84,,,27.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.68,,,23.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,25.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,15.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,25.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,15.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,27.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.15,,,29.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.31,,,23.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.03,,,23.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,15.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.81,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.84,,,27.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,28.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,14.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.68,29.15,
SODIUM POLYSTYRENE SULFONATE ORAL SUSP 15 GM/60ML,Rx46287000660,CDM,,,250,RC,46287-0006-60,NDC,,BOTH,60,ML,30.36,25.48,28.84,,,27.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.68,,,23.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,25.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,15.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,25.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,15.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,27.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.15,,,29.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.31,,,23.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.03,,,23.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,15.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.81,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.84,,,27.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.32,,,28.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.88,,,14.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.68,29.15,
HC TED HOSE THIGH HIGH LENGTH MED,Px00012777WNH,CDM,,,270,RC,,,,BOTH,,,30.48,27.43,28.96,,,27.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.77,,,23.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,25.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,15.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,25.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.94,,,15.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,27.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.26,,,29.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.4,,,23.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.08,,,23.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.04,,,28.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.94,,,15.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.91,,,25.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,27.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.43,,,28.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.94,,,14.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.77,29.26,
HC CUSHION RING INFLAT,Sx00000002216,CDM,,,270,RC,,,,BOTH,,,30.52,27.47,28.99,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.81,,,23.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,25.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,15.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,25.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.95,,,15.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.3,,,29.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.43,,,23.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.1,,,23.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.95,,,15.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.94,,,25.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.99,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,28.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14.95,,,14.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.81,29.3,
PHENOL LIQUID 1.4%,Rx78112001103,CDM,,,250,RC,78112-0011-03,NDC,,BOTH,1,EA,30.58,27.52,29.05,,,29.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.85,,,23.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.52,,,27.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.52,,,27.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.52,,,27.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.98,,,14.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.52,,,27.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.36,,,29.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.48,,,22.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.13,,,15.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.13,,,28.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.98,,,14.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.99,,,25.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.05,,,29.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.52,,,27.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,14.98,,,14.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.85,29.36,
"HC HUBER NEEDLE PT 19 1""",Px00006540WNH,CDM,,,270,RC,,,,BOTH,,,30.87,27.78,29.33,,,27.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.08,,,24.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,25.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,15.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,25.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,27.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.64,,,29.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.69,,,24.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.28,,,24.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.4,,,28.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,26.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.33,,,27.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,29.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.08,29.64,
HC HUBER NEEDLE 20 GUAGE,Px00006987WNH,CDM,,,270,RC,,,,BOTH,,,30.87,27.78,29.33,,,27.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.08,,,24.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,25.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,15.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,25.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,27.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.64,,,29.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.69,,,24.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.28,,,24.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.4,,,28.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.24,,,26.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.33,,,27.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.78,,,29.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.13,,,15.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.08,29.64,
HC BLANKET LOWER BODY PT TEMP BAIR HUGGER MODEL,Sx00000052500,CDM,,,270,RC,,,,BOTH,,,30.9,27.81,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.1,,,24.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,15.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.66,,,29.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.71,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.29,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.43,,,28.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,29.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.1,29.66,
HC BLANKET UPPER BODY PT BAIR HUGGER MODEL,Sx00000042268,CDM,,,270,RC,,,,BOTH,,,30.9,27.81,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.1,,,24.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,15.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.66,,,29.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.71,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.29,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.43,,,28.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,29.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.1,29.66,
HC PASTE CALAZIME 4 OZ REMEDY,Sx00MSC092554,CDM,,,270,RC,,,,BOTH,,,30.9,27.81,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.1,,,24.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,15.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,25.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.66,,,29.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.71,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.29,,,24.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.43,,,28.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.27,,,26.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.36,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,29.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.14,,,15.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.1,29.66,
FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT,Rx60505082901,CDM,,,250,RC,60505-0829-01,NDC,,BOTH,0.05,ME,30.93,21.07,29.38,,,27.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.13,,,24.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,15.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,25.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,27.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.69,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.73,,,24.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.31,,,24.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.46,,,28.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.29,,,26.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.38,,,27.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,29.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.16,,,15.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.13,29.69,
CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,Rx00591350804,CDM,,,250,RC,00591-3508-04,NDC,,BOTH,0.1,ME,30.96,27.86,29.41,,,29.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.15,,,24.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.72,,,29.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.76,,,22.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.32,,,15.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.48,,,28.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.32,,,26.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.41,,,29.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.15,29.72,
CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,Rx00591350854,CDM,,,250,RC,00591-3508-54,NDC,,BOTH,0.1,ME,30.96,27.86,29.41,,,29.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.15,,,24.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.72,,,29.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,22.76,,,22.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.32,,,15.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.48,,,28.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.32,,,26.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.41,,,29.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.17,,,15.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.15,29.72,
HC TOTAL PROTEIN,Px00030112314,CDM,84155,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD #,Px00030100636,CDM,84155,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD #,Px00030100638,CDM,84155,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROT ELP-PROTEIN TOTAL SERUM,Px00030015764,CDM,84155,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE #,Px00030100639,CDM,84156,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE #,Px00030100862,CDM,84156,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC ELP UR-PROTEIN TOTAL URINE,Px00030014776,CDM,84156,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN TOTAL URINE PAMC,Px00030015783,CDM,84156,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC PROTEIN TOTAL OTHER SOURCE,Px00030013090,CDM,84157,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC SYPHILIS TEST NON-TREP QUANT,Px00030210938,CDM,86593,CPT,300,RC,,,,BOTH,,,31,27.9,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.18,,,24.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,15.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,25.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.76,,,29.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.34,,,24.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.52,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.35,,,26.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.45,,,27.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.19,,,15.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.18,29.76,
HC DRESSING DUO DERM 6X6,Px00000894WNH,CDM,,,270,RC,,,,BOTH,,,31.29,28.16,29.73,,,28.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.41,,,24.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.16,,,26.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.16,,,15.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.16,,,26.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.33,,,15.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.16,,,28.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.04,,,30.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23,,,24.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.49,,,24.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.79,,,28.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.33,,,15.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.6,,,26.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.73,,,28.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.16,,,29.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.33,,,15.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.41,30.04,
SILVER SULFADIAZINE CREAM 1%,Rx67877012440,CDM,,,250,RC,67877-0124-40,NDC,,BOTH,1,EA,31.49,21.48,29.92,,,29.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.56,,,24.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.34,,,28.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.34,,,28.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.34,,,28.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.43,,,15.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.34,,,28.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.23,,,30.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.15,,,23.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15.58,,,15.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.97,,,28.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.43,,,15.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.77,,,26.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.92,,,29.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.34,,,28.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.43,,,15.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.56,30.23,
HC SPLINT COLLES RIGHT - SMALL,Px00000254WNH,CDM,,,270,RC,,,,BOTH,,,31.57,28.41,29.99,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,24.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,16.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.31,,,30.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,24.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.62,,,24.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.04,,,29.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,26.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.99,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,29.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,15.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.62,30.31,
HC HUBER NEEDLE 19 GUAGE,Px00001714WNH,CDM,,,270,RC,,,,BOTH,,,31.57,28.41,29.99,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,24.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,16.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.31,,,30.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,24.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.62,,,24.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.04,,,29.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,26.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.99,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,29.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,15.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.62,30.31,
HC LIGHTED SINGLE USE ANOSCOPE 23MM X 96MM,Sx0000C060110,CDM,,,270,RC,,,,BOTH,,,31.57,28.41,29.99,,,28.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,24.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,16.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,26.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,28.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.31,,,30.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,24.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.62,,,24.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.04,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,16.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,26.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.99,,,28.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.41,,,30,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.47,,,15.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.62,30.31,
HC HEADBED 11 LAERDAL CERVICAL IMMOBIL DEVICE,Sx00000982000,CDM,,,270,RC,,,,BOTH,,,31.68,28.51,30.1,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.71,,,24.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.51,,,26.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.51,,,16.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.51,,,26.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,16.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.51,,,28.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.41,,,30.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.28,,,24.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,24.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.15,,,29.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,16.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.93,,,26.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.1,,,28.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.51,,,30.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.52,,,15.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.71,30.41,
HC SPLINT COLLES,Px00032600WNH,CDM,,,270,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
HC GLUCOSE TOL ADDL SAMP 3HR,Px00030014989,CDM,82952,CPT,300,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
HC GTT-ADDED SAMPLES,Px00030112068,CDM,82952,CPT,300,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
HC PROTHROMBIN TIME,Px00030510032,CDM,85610,CPT,300,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
HC PROTHROMBIN TIME #,Px00030500214,CDM,85610,CPT,300,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
HC PROTHROMBIN TIME 85610,Px00030013952,CDM,85610,CPT,300,RC,,,,BOTH,,,32,28.8,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,24.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,16.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,26.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.72,,,30.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.84,,,24.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,16.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,27.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.4,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,30.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.68,,,15.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.96,30.72,
"HC GAYMAR HEATING PAD 15""X22""",Px00002867WNH,CDM,,,270,RC,,,,BOTH,,,32.06,28.85,30.46,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.01,,,25.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.85,,,26.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.85,,,16.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.85,,,26.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.71,,,16.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.85,,,28.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.78,,,30.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.56,,,25.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.87,,,25.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.5,,,29.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.71,,,16.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.25,,,27.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.46,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.85,,,30.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.71,,,15.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.01,30.78,
HC ABDOMINAL BINDER 10 27-48 UNIV,Px00011860WNH,CDM,,,270,RC,,,,BOTH,,,32.1,28.89,30.5,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.04,,,25.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,26.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,16.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,26.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.73,,,16.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.82,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.59,,,25.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15.89,,,25.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.53,,,29.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.73,,,16.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,27.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,30.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.73,,,15.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.04,30.82,
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED PREPACK-OR) INHAL AERS,Rx00000001192,CDM,,,250,RC,00000-0011-92,NDC,,BOTH,1,EA,32.44,29.2,30.82,,,29.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.3,,,25.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.2,,,27.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.2,,,16.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.2,,,27.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.9,,,16.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.2,,,29.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.14,,,31.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.84,,,25.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.05,,,25.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.84,,,29.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.9,,,16.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.57,,,27.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.82,,,29.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.2,,,30.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.9,,,15.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.3,31.14,
HC BRACE CLAVICLE SMALL HEAVY PADDED,Sx00079-85003,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,32.48,29.23,30.86,,,29.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.33,,,25.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,27.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,16.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,27.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,16.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,29.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.18,,,31.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.87,,,25.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,25.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.88,,,29.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,16.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.61,,,27.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,29.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,30.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,15.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.33,31.18,
HC BRACE CLAVICLE XLARGE HEAVY PADDED,Sx00079-85008,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,32.48,29.23,30.86,,,29.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.33,,,25.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,27.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,16.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,27.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,16.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,29.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.18,,,31.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.87,,,25.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.07,,,25.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.88,,,29.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,16.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.61,,,27.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,29.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.23,,,30.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.92,,,15.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.33,31.18,
HC LIGHTED SINGLE USE ANOSCOPE 90MM X 18MM SLOTTED,Sx0000C060100,CDM,,,270,RC,,,,BOTH,,,32.52,29.27,30.89,,,29.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.37,,,25.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,27.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,16.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,27.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.93,,,16.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,29.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.22,,,31.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.9,,,25.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.09,,,25.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.92,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.93,,,16.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.64,,,27.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.89,,,29.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,30.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15.93,,,15.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.37,31.22,
CYCLOPENTOLATE HCL OPHTH SOLN 1%,Rx17478010012,CDM,,,250,RC,17478-0100-12,NDC,,BOTH,1,EA,32.57,29.31,30.94,,,30.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.4,,,25.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.31,,,29.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.31,,,29.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.31,,,29.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.96,,,15.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.31,,,29.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,31.27,,,31.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.94,,,23.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16.12,,,16.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.96,,,29.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.96,,,15.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.68,,,27.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.94,,,30.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.31,,,29.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,15.96,,,15.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.4,31.27,
KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%,Rx61314012605,CDM,,,250,RC,61314-0126-05,NDC,,BOTH,1,EA,32.71,29.44,31.07,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.51,,,25.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,27.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,16.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,27.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.03,,,16.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.4,,,31.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.04,,,25.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.19,,,25.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.09,,,30.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.03,,,16.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.8,,,27.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.07,,,29.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.44,,,31.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.03,,,16.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.51,31.4,
HC TED HOSE THIGH LENGTH MED REG,Sx000003416LF,CDM,,,270,RC,,,,BOTH,,,32.76,29.48,31.12,,,29.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.55,,,25.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.48,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.48,,,16.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.48,,,27.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.05,,,16.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.48,,,29.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.45,,,31.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.08,,,25.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.21,,,25.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,30.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.05,,,16.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.85,,,27.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.12,,,29.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.48,,,31.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.05,,,16.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.55,31.45,
HC BRACE CLAVICLE MEDIUM HEAVY PADDED,Sx00079-85005,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,32.85,29.57,31.21,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.62,,,25.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,27.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,16.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,27.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.54,,,31.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.14,,,25.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,25.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.22,,,30.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,27.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.21,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,31.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.62,31.54,
HC BRACE CLAVICLE LARGE HEAVY PADDED,Sx00000085007,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,32.85,29.57,31.21,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.62,,,25.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,27.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,16.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,27.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.54,,,31.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.14,,,25.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,25.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.22,,,30.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,27.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.21,,,29.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.57,,,31.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.1,,,16.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.62,31.54,
HC PROTECTANT SKIN 4OZ.,Px00009110WNH,CDM,,,270,RC,,,,BOTH,,,32.88,29.59,31.24,,,29.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.65,,,25.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.59,,,27.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.59,,,16.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.59,,,27.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.11,,,16.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.59,,,29.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.56,,,31.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.17,,,25.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.27,,,25.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.25,,,30.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.11,,,16.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.95,,,27.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.24,,,29.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.59,,,31.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.11,,,16.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.65,31.56,
HC BIOPATCH DRESSING 1X4MM,Px00007586WNH,CDM,,,270,RC,,,,BOTH,,,32.94,29.65,31.29,,,29.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.69,,,25.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.65,,,27.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.65,,,16.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.65,,,27.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.14,,,16.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.65,,,29.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.62,,,31.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.21,,,25.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.3,,,25.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.3,,,30.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.14,,,16.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28,,,28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.29,,,29.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.65,,,31.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.14,,,16.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.69,31.62,
HC CHLORIDE BLOOD,Px00030014542,CDM,82435,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC POTASSIUM,Px00030112229,CDM,84132,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC ASSAY OF UREA NITROGEN QUANTITATIVE #,Px00030100667,CDM,84520,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC BUN,Px00030014459,CDM,84520,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC PLATELET COUNT,Px00030510082,CDM,85049,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC BLOOD COUNT PLATELET AUTOMATED #,Px00030500148,CDM,85049,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ #,Px00030610551,CDM,87185,CPT,300,RC,,,,BOTH,,,33,29.7,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.74,,,25.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,16.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,27.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.26,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.33,,,25.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.36,,,30.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,28.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.7,,,31.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.74,31.68,
HC OSTOMY NATURA KIT 45MM DURAHESIVE,Sx00000423559,CDM,,,270,RC,,,,BOTH,,,33.08,38.14,31.43,,,29.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.8,,,25.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,27.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,16.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,27.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.21,,,16.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,29.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.76,,,31.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.31,,,25.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.37,,,25.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.43,,,30.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.21,,,16.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.12,,,28.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.43,,,29.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,31.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.21,,,16.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.8,31.76,
IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML (ED PREPACK-OR) INHAL SOLN,Rx00000005836,CDM,,,250,RC,00000-0058-36,NDC,,BOTH,3,ML,33.19,29.87,31.53,,,29.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.89,,,25.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,27.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,16.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,27.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,16.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,29.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,31.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.39,,,25.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.43,,,25.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.53,,,30.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,16.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,28.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.53,,,29.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,31.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.26,,,16.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.89,31.86,
HC SHEET GURNEY IMPERVIOS PACU LF,Px00007506WNH,CDM,,,270,RC,,,,BOTH,,,33.25,29.93,31.59,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.94,,,25.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,27.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,27.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.92,,,31.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.44,,,25.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,25.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.26,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.59,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,31.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.94,31.92,
HC BRACE CLAVICLE - XLARGE,Px00000248WNH,CDM,L3650,CPT,274,RC,,,,BOTH,,,33.25,29.93,31.59,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.94,,,25.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,27.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,16.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,27.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.92,,,31.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.44,,,25.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,25.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.26,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.59,,,29.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.93,,,31.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.29,,,16.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.94,31.92,
HC STAPLER VISISTAT,Px00000924WNH,CDM,,,270,RC,,,,BOTH,,,33.36,30.02,31.69,,,30.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.02,,,26.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,27.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,27.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,30.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.03,,,32.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.52,,,26.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.51,,,26.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.69,,,30.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.36,,,28.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,30.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,31.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,16.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.02,32.03,
HC DRESSING BIOPATCH 1X4 ANTIMICROBIAL,Sx00000004150,CDM,,,270,RC,,,,BOTH,,,33.36,30.02,31.69,,,30.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.02,,,26.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,27.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,27.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,30.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.03,,,32.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.52,,,26.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.51,,,26.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.69,,,30.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.36,,,28.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,30.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,31.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.35,,,16.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.02,32.03,
HC CAST BOOT SANDAL SM DELUXE,Sx00079-81113,CDM,L3265,HCPCS,274,RC,,,,BOTH,,,33.49,30.14,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.12,,,26.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,30.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.15,,,32.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.57,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.47,,,28.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,16.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.12,32.15,
HC CAST BOOT SANDAL MED DELUXE,Sx00079-81115,CDM,L3265,HCPCS,274,RC,,,,BOTH,,,33.49,30.14,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.12,,,26.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,30.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.15,,,32.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.57,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.47,,,28.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,16.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.12,32.15,
HC CAST BOOT SANDAL LG DELUXE,Sx00079-81117,CDM,L3265,HCPCS,274,RC,,,,BOTH,,,33.49,30.14,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.12,,,26.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,17.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,30.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.15,,,32.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.57,,,26.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,17.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.47,,,28.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.82,,,30.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.41,,,16.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.12,32.15,
HC POLYMEM MAX 4.5 X 4.5 DRESSING,Px00011894WNH,CDM,,,270,RC,,,,BOTH,,,33.53,30.18,31.85,,,30.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.15,,,26.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.18,,,27.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.18,,,17.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.18,,,27.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.43,,,17.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.18,,,30.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.19,,,32.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.64,,,26.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.59,,,26.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.85,,,30.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.43,,,17.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.5,,,28.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,30.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.18,,,31.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.43,,,16.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.15,32.19,
HC CATH IV ANGIO 16X3.25 GRAY,Sx00000382258,CDM,,,270,RC,,,,BOTH,,,33.56,30.2,31.88,,,30.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.18,,,26.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.2,,,27.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.2,,,17.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.2,,,27.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.44,,,17.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.2,,,30.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.22,,,32.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.67,,,26.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,26.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.88,,,30.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.44,,,17.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.53,,,28.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.88,,,30.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.2,,,31.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.44,,,16.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.18,32.22,
HC BRACE CLAVICLE PED XSM HEAVY PADDED,Sx00000085022,CDM,,,270,RC,,,,BOTH,,,33.6,30.24,31.92,,,30.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.21,,,26.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,27.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,17.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,27.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,17.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,30.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.26,,,32.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.7,,,26.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.63,,,26.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.91,,,30.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,17.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.56,,,28.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.92,,,30.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,31.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,16.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.21,32.26,
HC TED HOSE THIGH LENGTH LG REG,Sx000003728LF,CDM,,,270,RC,,,,BOTH,,,33.65,30.29,31.97,,,30.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.25,,,26.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.29,,,28.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.29,,,17.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.29,,,28.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.49,,,17.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.29,,,30.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,32.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.73,,,26.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,26.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.96,,,30.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.49,,,17.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.6,,,28.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.97,,,30.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.29,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.49,,,16.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.25,32.3,
HC PENCIL CAUTERY FT FINE TIP DISP,Sx0000000AA01,CDM,,,270,RC,,,,BOTH,,,33.89,34.44,32.2,,,30.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.43,,,26.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,28.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,17.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,28.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,17.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,30.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.53,,,32.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.91,,,26.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.77,,,26.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.18,,,31.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,17.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.81,,,28.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.2,,,30.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,32.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,16.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.43,32.53,
HC CAUTERY PENCIL LOOP LOOP TIP DISP,Sx0000000AA03,CDM,,,270,RC,,,,BOTH,,,33.89,34.44,32.2,,,30.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.43,,,26.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,28.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,17.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,28.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,17.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,30.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.53,,,32.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.91,,,26.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.77,,,26.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.18,,,31.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,17.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.81,,,28.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.2,,,30.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.5,,,32.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.61,,,16.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.43,32.53,
HC CAST BOOT SANDAL MED 81015,Px00000238WNH,CDM,,,270,RC,,,,BOTH,,,33.95,30.56,32.25,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.48,,,26.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,17.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,17.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.59,,,32.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.95,,,26.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.8,,,26.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.23,,,31.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,17.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.86,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,32.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,16.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.48,32.59,
"HC PLASTAZOTE SANDAL, EA",Px00000237WNH,CDM,L3265,CPT,274,RC,,,,BOTH,,,33.95,30.56,32.25,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.48,,,26.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,17.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,28.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,17.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.59,,,32.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.95,,,26.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.8,,,26.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.23,,,31.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,17.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.86,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,30.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,32.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,16.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.48,32.59,
HC SPONGE GELFOAM ST 7MM STERILE AB,Sx00000001972,CDM,,,270,RC,,,,BOTH,,,33.97,30.57,32.27,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.5,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.57,,,28.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.57,,,17.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.57,,,28.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,17.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.57,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.61,,,32.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.97,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.81,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.25,,,31.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,17.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.87,,,28.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.27,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.57,,,32.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,16.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.5,32.61,
HC AIRWAY ORAL OVASSAPIAN 85MM FIBEROPTIC INTUBATING,Sx00000BD6075,CDM,,,270,RC,,,,BOTH,,,33.98,30.58,32.28,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.5,,,26.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.58,,,28.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.58,,,17.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.58,,,28.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,17.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.58,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.62,,,32.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.98,,,26.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.82,,,26.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.26,,,31.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,17.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.88,,,28.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.28,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.58,,,32.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.65,,,16.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.5,32.62,
HC ADMIN PNEUMOCOCCAL VACCINE,Px00077110004,CDM,90471,CPT,771,RC,,,,BOTH,,,34,30.6,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.28,,,31.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,16.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.52,32.64,
HC ASSAY CALCIUM IN URINE,Px00030112937,CDM,82340,CPT,300,RC,,,,BOTH,,,34,30.6,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,17.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.83,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.28,,,31.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,16.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.52,32.64,
HC ASSAY OF URINE SODIUM #,Px00030100652,CDM,84300,CPT,300,RC,,,,BOTH,,,34,30.6,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,17.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.83,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.28,,,31.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,16.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.52,32.64,
HC SODIUM URINE,Px00030112172,CDM,84300,CPT,300,RC,,,,BOTH,,,34,30.6,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,17.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.83,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.28,,,31.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,16.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.52,32.64,
HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD #,Px00030510006,CDM,85730,CPT,300,RC,,,,BOTH,,,34,30.6,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,17.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,28.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.83,,,26.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.28,,,31.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,17.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,28.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.66,,,16.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.52,32.64,
HC LACTATE DEHYDROGENASE LDH #,Px00030100185,CDM,83615,CPT,300,RC,,,,BOTH,,,34.07,30.66,32.37,,,30.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.57,,,26.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,28.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,17.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,28.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.69,,,17.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,30.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.71,,,32.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.04,,,26.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.86,,,26.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.34,,,31.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.69,,,17.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,28.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.37,,,30.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,32.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.69,,,16.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.57,32.71,
HC SUT MONOCRYL 4-0 PS-2 UNDYED BIOSYN 18,Sx000000Y496G,CDM,,,270,RC,,,,BOTH,,,34.08,28.96,32.38,,,28.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.58,,,25.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.67,,,26.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.67,,,16.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.67,,,26.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.7,,,16.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.67,,,28.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.72,,,30.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.05,,,25.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.87,,,25.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.7,,,16.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.97,,,27.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.38,,,28.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.67,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.7,,,16.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.58,32.72,
HC ALGERBRUSH BURR 1MM,Px00002276WNH,CDM,,,270,RC,,,,BOTH,,,34.3,30.87,32.59,,,30.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.75,,,26.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,28.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,17.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,28.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.81,,,17.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,30.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.93,,,32.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.21,,,26.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.98,,,26.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.56,,,31.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.81,,,17.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.16,,,29.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.59,,,30.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.81,,,16.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.75,32.93,
HC K WIRE .045 SMOOTH 4 IN 47018607000 ZIMMER,Sx0047-186-70,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,34.36,34.43,32.64,,,30.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,26.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.92,,,28.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.92,,,17.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.92,,,28.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.84,,,17.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.92,,,30.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,32.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.25,,,26.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17,,,26.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.61,,,31.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.84,,,17.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.21,,,29.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.64,,,30.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.92,,,32.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.84,,,16.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.8,32.99,
HC FOAM DRESSING <+16 SQ IN W/BOR,Px00011971WNH,CDM,,,270,RC,,,,BOTH,,,34.44,31,32.72,,,31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.86,,,26.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31,,,28.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31,,,17.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31,,,28.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.88,,,17.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31,,,31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.06,,,33.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.31,,,26.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.04,,,26.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.68,,,31.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.88,,,17.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,29.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.72,,,31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31,,,32.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16.88,,,16.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.86,33.06,
HC PR ED 29540 STRAPPING OF ANKLE AND/OR FT CDM,Px00098110481,CDM,29540,CPT,981,RC,,,,OUTPATIENT,,,65,58.5,36.4,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,50.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,54.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,33.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.63,,,54.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.38,,,33.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.51,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.75,,,62.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.85,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.85,,,50.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,59.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,17.36,,,33.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,55.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.4,,,58.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.31,,,61.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.85,,,16.85,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,16.85,33.31,
HC NEEDLE HUBER 19X3/4,Sx021-2868-24,CDM,,,270,RC,,,,BOTH,,,34.83,27.75,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,17.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,33.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.24,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.61,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.17,33.44,
HC NEEDLE HUBER 19GX1 GRIP,Sx021-2869-24,CDM,,,270,RC,,,,BOTH,,,34.83,27.75,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,17.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,33.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.24,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.61,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.17,33.44,
HC NEEDLE HUBER 20GX3/4,Sx021-2865-24,CDM,,,270,RC,,,,BOTH,,,34.83,27.75,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,17.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,33.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.24,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.61,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.17,33.44,
HC NEEDLE HUBER 20G GRIP 0,Sx021-2866-24,CDM,,,270,RC,,,,BOTH,,,34.83,27.75,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,17.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,33.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.24,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.61,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.17,33.44,
HC NEEDLE HUBER 20GX1.25 GRIP SPEC PT NEED,Sx021-2763-24,CDM,,,270,RC,,,,BOTH,,,34.83,27.75,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,27.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,17.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,33.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.6,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.24,,,27.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.61,,,29.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.09,,,31.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.07,,,17.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.17,33.44,
PROPARACAINE HCL OPHTH SOLN 0.5%,Rx61314001601,CDM,,,250,RC,61314-0016-01,NDC,,BOTH,1,EA,34.91,31.08,33.16,,,31.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.23,,,27.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,29.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,17.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,29.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,17.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,31.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.51,,,33.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.66,,,27.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.28,,,27.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.12,,,32.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,17.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.67,,,29.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.16,,,31.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,33.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.11,,,17.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.23,33.51,
HC PR 01991 ANESTH NERVE BLOCK/INJ,Px00096310203,CDM,1991,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01732 ANESTH DX ELBOW ARTHROSCOPY,Px00096310170,CDM,1732,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01820 ANESTH LOWER ARM PROCEDURE,Px00096310180,CDM,1820,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01470 ANESTH LOWER LEG SURGERY,Px00096310144,CDM,1470,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01710 ANESTH ELBOW AREA SURGERY,Px00096310165,CDM,1710,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 00322 ANESTH BIOPSY OF THYROID,Px00096310025,CDM,322,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01380 ANESTH KNEE JOINT PROCEDURE,Px00096310130,CDM,1380,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01382 ANESTH DX KNEE ARTHROSCOPY,Px00096310131,CDM,1382,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01464 ANESTH ANKLE/FT ARTHROSCOPY,Px00096310143,CDM,1464,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01830 ANESTH LOWER ARM SURGERY,Px00096310182,CDM,1830,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 00400 ANESTH SKIN EXT/PER/ATRUNK,Px00096310028,CDM,400,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 00940 ANESTH VAGINAL PROCEDURES,Px00096310104,CDM,940,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01480 ANESTH LOWER LEG BONE SURG,Px00096310147,CDM,1480,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 00812 ANES LWR INTST SCR COLSC,Px00096310285,CDM,812,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01951 ANESTH BURN LESS 4 PERCENT CDM,Px00096310347,CDM,1951,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,47.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01390 ANESTH KNEE AREA PROCEDURE,Px00096310132,CDM,1390,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC PR 01810 ANESTH LOWER ARM SURGERY,Px00096310179,CDM,1810,CPT,963,RC,,,,BOTH,,,51.6,46.44,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,54.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,57.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.38,,,55.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.86,,,44.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,44.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,52.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.51,,,29.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.41,,,48.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.9,,,51.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.54,,,54.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,33.54,BASE FEE
HC IMMOBILIZER HEAD STA-BLOK,Sx00700-00001,CDM,,,270,RC,,,,BOTH,,,34.99,31.49,33.24,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.29,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.49,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.49,,,17.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.49,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.49,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.59,,,33.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.72,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.32,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.19,,,32.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.74,,,29.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.24,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.49,,,33.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.29,33.59,
HC CHOLESTEROL,Px00030112251,CDM,82465,CPT,300,RC,,,,BOTH,,,35,31.5,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.3,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,17.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.6,,,33.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.32,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.2,,,32.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,29.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,33.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.3,33.6,
HC FATS/LIPIDS FECES QUAL,Px00030710011,CDM,82705,CPT,300,RC,,,,BOTH,,,35,31.5,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.3,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,17.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.6,,,33.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.32,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.2,,,32.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,29.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,33.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.3,33.6,
HC SODIUM,Px00030013978,CDM,84295,CPT,300,RC,,,,BOTH,,,35,31.5,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.3,,,27.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,17.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,29.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.6,,,33.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.32,,,27.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.2,,,32.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,29.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.25,,,31.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.5,,,33.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.15,,,17.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.3,33.6,
HC SHEET GURNEY IMPERVIOS 54X100 0,Sx00ATC54100N,CDM,,,270,RC,,,,BOTH,,,35.25,30.84,33.49,,,31.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.5,,,27.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.73,,,29.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.73,,,17.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.73,,,29.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.27,,,17.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.73,,,31.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.84,,,33.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.91,,,27.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.45,,,27.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.43,,,32.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.27,,,17.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.96,,,29.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.49,,,31.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.73,,,33.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.27,,,17.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.5,33.84,
HC UNIVERSAL ABDOMINAL BINDER 9 IN 9 IN H X 27-48,Sx000ORT21100,CDM,,,270,RC,,,,BOTH,,,35.82,96.88,34.03,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.94,,,86.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.24,,,92.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.24,,,56.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.24,,,92.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.55,,,56.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.24,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.39,,,106.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.33,,,86.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.73,,,86.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.95,,,102.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.55,,,56.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.45,,,94.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.03,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.24,,,105.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.55,,,17.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.94,34.39,
HC RH IG FULL-DOSE IM,Px00026010028,CDM,90384,CPT,260,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC INFUSION SET POWER LOC,Px00011067WNH,CDM,,,270,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC INFUSION SET POWER LOC,Px00012981WNH,CDM,,,270,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC TUBING Y SITE INJECTION PORT 22 GA X .75,Sx00000672234,CDM,,,270,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC THROMBOPLASTIN TIME PARTIAL 50-50,Px00030510067,CDM,85732,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPECIFIC IGE,Px00030210302,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,Px00030210382,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPECIFIC IGE - IGE QUANT,Px00030210904,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,Px00030200090,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,Px00030200135,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,Px00030200494,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,Px00030200496,CDM,86003,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC SMEAR WET MOUNT SALINE/INK - KOH EXAM,Px00030011260,CDM,87210,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM #,Px00030011261,CDM,87210,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
HC TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT #,Px00030600131,CDM,87220,CPT,300,RC,,,,BOTH,,,36,32.4,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.08,,,28.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,18.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,29.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.56,,,34.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.82,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,18.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.6,,,30.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,32.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.64,,,17.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.08,34.56,
"HC PR 15272 GRAFT TRUNK,ARM,LEG, TOTAL TO 100 SQCM; EA ADDL 25 SQCM",Px00098210037,CDM,15272,CPT,982,RC,,,,BOTH,,,58,52.2,32.48,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.21,,,45.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,45.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,18.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,45.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.58,,,18.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.04,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.9,,,55.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.16,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16.16,,,45.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.06,,,53.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.64,,,18.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.06,,,49.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.48,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.65,,,55.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.16,,,16.16,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,16.16,34.65,
HC STAPLER VISISTAT 35W 35 STAPLES DISP,Sx00000528235,CDM,,,270,RC,,,,BOTH,,,36.41,30.03,34.59,,,30.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.4,,,26.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.77,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.77,,,17.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.77,,,27.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.84,,,17.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.77,,,30.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.95,,,32.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,26.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.02,,,26.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.5,,,30.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.84,,,17.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.95,,,28.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.59,,,30.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.77,,,31.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.84,,,17.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.4,34.95,
HC IRON (FE)-,Px00030113527,CDM,83540,CPT,300,RC,,,,BOTH,,,36.49,32.84,34.67,,,32.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.46,,,28.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,30.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,18.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,30.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,18.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,32.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.03,,,35.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.82,,,28.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.06,,,28.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.57,,,33.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,18.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.02,,,31.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.67,,,32.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,34.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,17.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.46,35.03,
HC ASSAY OF IRON #,Px00030100900,CDM,83540,CPT,300,RC,,,,BOTH,,,36.49,32.84,34.67,,,32.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.46,,,28.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,30.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,18.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,30.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,18.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,32.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.03,,,35.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.82,,,28.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.06,,,28.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.57,,,33.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,18.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.02,,,31.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.67,,,32.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.84,,,34.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.88,,,17.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.46,35.03,
HC UNIVERSAL ABDOMINAL BINDER 10 IN 10 IN H X 27-48,Sx000ORT21200,CDM,,,270,RC,,,,BOTH,,,36.66,70.52,34.83,,,70.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.59,,,61.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,39.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.96,,,39.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,70.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.19,,,75.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,61.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.14,,,61.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.73,,,72.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.96,,,39.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.16,,,66.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.83,,,70.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.99,,,74.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17.96,,,17.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.59,35.19,
PROMETHAZINE HCL 25 MG (ED PREPACK-OR) RECTAL SUPP,Rx00000003130,CDM,,,250,RC,00000-0031-30,NDC,,BOTH,25,ME,36.92,33.23,35.07,,,33.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.8,,,28.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.23,,,30.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.23,,,18.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.23,,,30.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.09,,,18.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.23,,,33.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.44,,,35.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.14,,,28.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.27,,,28.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.97,,,33.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.09,,,18.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.38,,,31.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.07,,,33.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.23,,,35.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.09,,,18.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.8,35.44,
HC DISPOSABLE STAPLER 35 W,Px00003174WNH,CDM,,,270,RC,,,,BOTH,,,36.96,33.26,35.11,,,33.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.83,,,28.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.26,,,30.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.26,,,18.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.26,,,30.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.11,,,18.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.26,,,33.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.48,,,35.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.17,,,28.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.29,,,28.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.11,,,18.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.42,,,31.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.11,,,33.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.26,,,35.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.11,,,18.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.83,35.48,
HC ASSAY OF BLOOD/URIC ACID #,Px00030100668,CDM,84550,CPT,300,RC,,,,BOTH,,,37,33.3,35.15,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.86,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,30.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,18.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,30.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.52,,,35.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,28.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.31,,,28.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.04,,,34.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.45,,,31.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.86,35.52,
HC URIC ACID BLOOD,Px00030110077,CDM,84550,CPT,300,RC,,,,BOTH,,,37,33.3,35.15,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.86,,,28.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,30.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,18.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,30.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.52,,,35.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,28.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.31,,,28.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.04,,,34.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.45,,,31.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.3,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,18.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.86,35.52,
FENTANYL TD PATCH 72HR 100 MCG/HR,Rx00406900076,CDM,,,250,RC,00406-9000-76,NDC,,BOTH,0.1,ME,37.91,34.12,36.01,,,36.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.57,,,29.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,,,34.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,,,34.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,,,34.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.58,,,18.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,,,34.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.39,,,36.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.86,,,27.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,18.76,,,18.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.88,,,34.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.58,,,18.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.22,,,32.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.01,,,36.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,,,34.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,18.58,,,18.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.57,36.39,
HC COVER PROBE INTRAOPERATIVE 5X96 STERILE,Sx00000PC1308,CDM,,,270,RC,,,,BOTH,,,37.98,33.57,36.08,,,34.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.62,,,29.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,31.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,19.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,31.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.61,,,19.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,34.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,36.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,29.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.8,,,29.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.94,,,34.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.61,,,19.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.28,,,32.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.08,,,34.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,36.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.61,,,18.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.62,36.46,
HC GLUCOSE POST GLUCOSE DOSE #,Px00030100616,CDM,82950,CPT,300,RC,,,,BOTH,,,38,34.2,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.64,,,29.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,19.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.96,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,36.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,18.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.64,36.48,
HC GLUCOSE POST GLUCOSE DOSE (INCLUDES GLUCOSE),Px00030014980,CDM,82950,CPT,300,RC,,,,BOTH,,,38,34.2,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.64,,,29.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,19.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.96,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,36.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,18.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.64,36.48,
HC ASSAY PHOSPHORUS,Px00030112107,CDM,84100,CPT,300,RC,,,,BOTH,,,38,34.2,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.64,,,29.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,19.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,31.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.81,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.96,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,19.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,32.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.1,,,34.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,36.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.62,,,18.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.64,36.48,
CLOBETASOL PROPIONATE CREAM 0.05%,Rx00168016330,CDM,,,250,RC,00168-0163-30,NDC,,BOTH,1,EA,38.17,34.35,36.26,,,34.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,29.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.35,,,31.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.35,,,19.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.35,,,31.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,19.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.35,,,34.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.64,,,36.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,29.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.89,,,29.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.12,,,35.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,19.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.44,,,32.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,34.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.35,,,36.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.7,,,18.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.77,36.64,
PROCHLORPERAZINE 25 MG (ED PREPACK-OR) RE SUPP,Rx00000003746,CDM,,,250,RC,00000-0037-46,NDC,,BOTH,25,ME,38.32,34.49,36.4,,,24.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,21.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.49,,,22.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.49,,,13.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.49,,,22.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.78,,,13.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.49,,,24.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.79,,,25.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.17,,,21.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.96,,,21.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.25,,,24.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.78,,,13.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.57,,,22.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.4,,,24.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.49,,,25.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18.78,,,18.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.89,36.79,
HC PR ED 29530 STRAPPING OF KNEE CDM,Px00098110626,CDM,29530,CPT,981,RC,,,,OUTPATIENT,,,71,63.9,39.76,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.59,,,55.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,59.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,36.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,59.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.24,,,36.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.4,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.05,,,68.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,17.6,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17.6,,,55.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.47,,,65.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,36.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.47,,,60.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.76,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,67.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,17.6,,,17.6,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,17.6,36.9,
HC PR ED 29260 STRAPPING OF ELBOW OR WRIST CDM,Px00098110473,CDM,29260,CPT,981,RC,,,,OUTPATIENT,,,70,63,39.2,,,63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.17,,,54.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,58.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,35.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,58.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.92,,,35.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.5,,,67.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.19,,,54.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18.19,,,54.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,64.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.74,,,35.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,59.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.35,,,66.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.19,,,18.19,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,18.19,37.35,
"HC UNNA-FLEX DRESSING 4""",Px00004330WNH,CDM,,,270,RC,,,,BOTH,,,38.94,35.05,36.99,,,35.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.37,,,30.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.05,,,32.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.05,,,19.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.05,,,32.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.08,,,19.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.05,,,35.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.38,,,37.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.62,,,30.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.27,,,30.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.82,,,35.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.08,,,19.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.1,,,33.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.99,,,35.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.05,,,36.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.08,,,19.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.37,37.38,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx00955100410,CDM,J1650,HCPCS,636,RC,955100410,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx68001045842,CDM,J1650,HCPCS,636,RC,68001045842,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx68001045843,CDM,J1650,HCPCS,636,RC,68001045843,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx71288041082,CDM,J1650,HCPCS,636,RC,71288041082,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx71288041083,CDM,J1650,HCPCS,636,RC,71288041083,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx71288043391,CDM,J1650,HCPCS,636,RC,71288043391,NDC,,BOTH,0.4,ML,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
GLYCERIN SUPPOS 2 GM,Rx00132007924,CDM,,,250,RC,00132-0079-24,NDC,,BOTH,2,GR,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.3,,,19.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
BENZOCAINE-MENTHOL AEROSOL 20-0.5%,Rx16864068003,CDM,,,250,RC,16864-0680-03,NDC,,BOTH,1,EA,39,35.1,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.67,,,28.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.3,,,19.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
PRAMOX-PE-GLYCERIN-PETROLATUM PERIANAL CREAM 1-0.25-14.4-15%,Rx00573286893,CDM,,,250,RC,00573-2868-93,NDC,,BOTH,1,EA,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
ASPIRIN SUPPOS 300 MG,Rx00574703412,CDM,,,250,RC,00574-7034-12,NDC,,BOTH,300,ME,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
CARBAMIDE PEROXIDE 6.5% OTIC SOLN,Rx00904662735,CDM,,,250,RC,00904-6627-35,NDC,,BOTH,1,EA,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
BENZOCAINE-MENTHOL AEROSOL 20-0.5%,Rx51409000722,CDM,,,250,RC,51409-0007-22,NDC,,BOTH,1,EA,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
GLYCERIN SUPPOS 1 GM,Rx58980040912,CDM,,,250,RC,58980-0409-12,NDC,,BOTH,1,GR,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
GLYCERIN SUPPOS 2 GM,Rx58980041012,CDM,,,250,RC,58980-0410-12,NDC,,BOTH,2,GR,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC CARBON DIOXIDE CONTENT,Px00030014495,CDM,82374,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC BLEEDING TIME TEST #,Px00030510025,CDM,85002,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC C-REACTIVE PROTEIN,Px00030210399,CDM,86140,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC C-REACTIVE PROTEIN #,Px00030200504,CDM,86140,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC C-REACTIVE PROTEIN #,Px00030200505,CDM,86140,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC SMEAR GRAM STAIN,Px00030610563,CDM,87205,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,Px00030610573,CDM,87205,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,Px00030600082,CDM,87205,CPT,300,RC,,,,BOTH,,,39,35.1,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.42,,,30.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,19.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,32.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.67,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.3,,,30.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.15,,,33.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.05,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,37.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.11,,,19.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,37.44,
HC DRESSING COLLAGEN PURACOL 4X4.25,Sx000MSC8544Z,CDM,,,270,RC,,,,BOTH,,,39.04,35.14,37.09,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.45,,,30.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,32.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,19.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,32.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.13,,,19.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.48,,,37.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.69,,,30.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.32,,,30.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.92,,,35.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.13,,,19.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.18,,,33.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.09,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,37.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.13,,,19.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.45,37.48,
HC BRACE WRIST LT SMALL COMFORT FORM LYCRA/SPANDEX,Sx00079-87293,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.06,35.15,37.11,,,35.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.47,,,30.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,32.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,19.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,32.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.14,,,19.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.5,,,37.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.71,,,30.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.33,,,30.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,35.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.14,,,19.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.2,,,33.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.11,,,35.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,37.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.14,,,19.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.47,37.5,
HC PR ED 29280 STRAPPING OF HAND OR FINGER CDM,Px00098110475,CDM,29280,CPT,981,RC,,,,OUTPATIENT,,,69,62.1,38.64,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.17,,,53.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,57.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,35.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,57.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.99,,,35.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.04,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.95,,,66.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,53.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,53.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.33,,,63.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.69,,,35.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.33,,,58.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,62.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.81,,,65.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.12,,,19.12,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,19.12,37.81,
HC DRAIN JACKSON-PRATT/7MM SILICONE FLAT DRAIN,Sx0SU130-1410,CDM,,,270,RC,,,,BOTH,,,39.44,33.04,37.47,,,35.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.76,,,30.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,32.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,20.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,32.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.33,,,20.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,35.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.86,,,37.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.99,,,30.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.52,,,30.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.28,,,36.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.33,,,20.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.52,,,33.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.47,,,35.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,37.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.33,,,19.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.76,37.86,
HC BRACE WRIST RT MED COMFORT FORM VYCRA/SPANDES,Sx00079-87285,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST RT LG COMFORT FORM LYCRA/SPANDEX,Sx00079-87287,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST RT XLG COMFORT FORM LYCRA/SPANDEX,Sx00079-87288,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST LT MED COMFORT FORM LYCRA/SPANDEX,Sx00079-87295,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST LT LARGE COMFORT FORM LYCRA/SPANDEX,Sx00079-87297,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST LT XLG COMFORT FORM LYCRA/SPANDEX,Sx00079-87298,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC BRACE WRIST RT SM COMFORT FORM LYCRA/SPANDEX,Sx00079-87283,CDM,L3908,HCPCS,274,RC,,,,BOTH,,,39.5,35.55,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.81,,,30.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,20.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,32.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.92,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.55,,,30.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,36.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,20.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.58,,,33.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.55,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.36,,,19.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.81,37.92,
HC EYE GUARD STERILE LTX FREE,Px00010225WNH,CDM,,,270,RC,,,,BOTH,,,39.6,35.64,37.62,,,35.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.89,,,30.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.64,,,32.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.64,,,20.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.64,,,32.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.4,,,20.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.64,,,35.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.02,,,38.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,30.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,30.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.43,,,36.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.4,,,20.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.66,,,33.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.62,,,35.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.64,,,37.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.4,,,19.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.89,38.02,
NITROGLYCERIN OINT 2%,Rx00281032630,CDM,,,250,RC,00281-0326-30,NDC,,BOTH,1,EA,39.66,32.5,37.68,,,35.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.93,,,30.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.69,,,33.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.69,,,20.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.69,,,33.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.43,,,20.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.69,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.07,,,38.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.15,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.63,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.49,,,36.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.43,,,20.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.71,,,33.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.68,,,35.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.69,,,37.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.43,,,19.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.93,38.07,
HC PR 97607 NEG PRESS WND TX UTILIZING DISP NON DME EQUIP<50SQ CM,Px00096911124,CDM,97607,CPT,983,RC,,,,BOTH,,,53,47.7,29.68,,,47.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.48,,,41.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.13,,,44.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.13,,,27.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.13,,,44.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.43,,,27.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.5,,,47.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.15,,,50.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,41.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.21,,,48.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.98,,,27.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.21,,,45.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.68,,,47.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.13,,,50.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,20.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,20.37,38.13,
HC SOL IRRI 0.9 PCT NACL IRRG 3000ML BAXTER,Sx000002B7477,CDM,,,270,RC,,,,BOTH,,,39.81,43.01,37.82,,,43.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.05,,,37.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.83,,,39.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.83,,,24.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.83,,,39.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.51,,,24.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.83,,,43.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,45.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.26,,,37.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.7,,,37.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.63,,,44.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.51,,,24.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.84,,,40.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.82,,,43.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.83,,,45.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.51,,,19.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.05,38.22,
HC SPEC COLL NON-BLOOD:A/D TEST #,Px00030012366,CDM,H0048,CPT,300,RC,,,,BOTH,,,40,36,38,,,38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.4,,,29.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.8,,,19.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38,,,38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BRACE WRIST RT LG,Px00001281WNH,CDM,L3908,CPT,274,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BRACE WRIST LT LG,Px00001285WNH,CDM,L3908,CPT,274,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BRACE WRIST COMFORT FORM LYCRA/SPANDEX,Px00032400WNH,CDM,L3908,CPT,274,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC ALBUMIN SERUM PLASMA/WHOLE BLOOD #,Px00030100562,CDM,82040,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC ASSAY OF SERUM ALBUMIN,Px00030112003,CDM,82040,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN TOTAL #,Px00030100570,CDM,82247,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN TOTAL #,Px00030100571,CDM,82247,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN TOTAL #,Px00030100775,CDM,82247,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN TOTAL,Px00030112023,CDM,82247,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN DIRECT #,Px00030100572,CDM,82248,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BILIRUBIN DIRECT,Px00030112043,CDM,82248,CPT,300,RC,,,,BOTH,,,40,36,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.2,,,31.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,20.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.4,,,38.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,31.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.8,,,36.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,20.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34,,,34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38,,,36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.6,,,19.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.2,38.4,
HC BRACE WRIST RT MED,Px00001280WNH,CDM,L3908,CPT,274,RC,,,,BOTH,,,40.08,36.07,38.08,,,36.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.26,,,31.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.07,,,33.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.07,,,20.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.07,,,33.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.64,,,20.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.07,,,36.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.48,,,38.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.46,,,31.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19.84,,,31.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.87,,,36.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.64,,,20.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.07,,,34.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.08,,,36.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.07,,,38.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.64,,,19.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.26,38.48,
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,Rx50383066730,CDM,,,250,RC,50383-0667-30,NDC,,BOTH,1,EA,40.27,36.24,38.26,,,38.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,31.41,,,31.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.24,,,36.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.24,,,36.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.24,,,36.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.73,,,19.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.24,,,36.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.66,,,38.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.6,,,29.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19.93,,,19.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.05,,,37.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.73,,,19.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.23,,,34.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.26,,,38.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.24,,,36.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,19.73,,,19.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.41,38.66,
HC IMMOBILIZER SHOULDER M XLG 44 IN-48 IN ELASTIC,Sx00007984038,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,40.56,36.5,38.53,,,36.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.64,,,31.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,20.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,20.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,36.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.94,,,38.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.81,,,31.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.07,,,31.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.32,,,37.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,20.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.48,,,34.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,36.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,38.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,19.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.64,38.94,
HC IMMOBILIZER SHOULDER M XXLG 48 IN-52 IN ELASTIC,Sx00079-84039,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,40.56,36.5,38.53,,,36.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.64,,,31.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,20.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,20.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,36.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.94,,,38.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.81,,,31.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.07,,,31.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.32,,,37.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,20.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.48,,,34.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,36.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.5,,,38.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.87,,,19.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.64,38.94,
HC UNIVERSAL ABDOMINAL BINDER 12 IN 12 IN H 27-48,Sx000ORT21300,CDM,,,270,RC,,,,BOTH,,,40.74,91.31,38.7,,,91.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.78,,,79.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.67,,,84.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.67,,,51.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.67,,,84.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.96,,,51.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.67,,,91.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.11,,,97.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.94,,,79.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.16,,,79.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.48,,,93.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.96,,,51.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.63,,,86.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.7,,,91.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.67,,,96.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19.96,,,19.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.78,39.11,
HC AIRWAY LMA UNIQUE NO 4 SINGLE USE DISP,Sx0000159-004,CDM,,,270,RC,,,,BOTH,,,40.85,36.77,38.81,,,36.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,31.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.77,,,34.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.77,,,20.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.77,,,34.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.02,,,20.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.77,,,36.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,39.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,31.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.22,,,31.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.58,,,37.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.02,,,20.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.72,,,34.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.81,,,36.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.77,,,38.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.02,,,20.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.86,39.22,
HC BRACE CLAVICLE,Px00032500WNH,CDM,L3650,CPT,274,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC CALCIUM TOTAL #,Px00030100574,CDM,82310,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC CALCIUM SERUM,Px00030013847,CDM,82310,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC ASSAY CREATININE,Px00030112217,CDM,82565,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC ASSAY OF PHOSPHATASE ALKALINE #,Px00030100632,CDM,84075,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC ALKALINE PHOS,Px00030014138,CDM,84075,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC SGOT (AST),Px00030112384,CDM,84450,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC RETICYTE/HGB CONCENTRATE,Px00030013969,CDM,85046,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC HETEROPHILE ANTIBODIES,Px00030210538,CDM,86308,CPT,300,RC,,,,BOTH,,,41,36.9,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.98,,,31.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,20.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,34.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.36,,,39.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.29,,,31.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.72,,,37.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.85,,,34.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.98,39.36,
HC TED HOSE THIGH LENGTH XL REG,Sx000003181LF,CDM,,,270,RC,,,,BOTH,,,41.01,36.91,38.96,,,36.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.99,,,31.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.91,,,34.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.91,,,20.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.91,,,34.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.91,,,36.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.37,,,39.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.14,,,31.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,31.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,37.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.86,,,34.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,36.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.91,,,38.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.09,,,20.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,31.99,39.37,
HC IMMOBILIZER SHOULDER F XXL 42-48 IN ELASTIC,Sx00079-84049,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.49,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,31.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,38.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER F MED 28 IN-32 IN ELASTIC,Sx00000084045,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.49,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,31.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,38.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER F LG 32 IN-36 IN ELASTIC,Sx00079-84047,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.49,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,31.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,38.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER F XL 36 IN-42 IN ELASTIC,Sx00079-84048,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.49,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,31.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,33.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,38.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,31.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER M SMALL 32 IN-36 IN ELASTIC,Sx00000084033,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.92,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,39.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER M MED 36 IN-40 IN ELASTIC,Sx00000084035,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.92,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,39.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC IMMOBILIZER SHOULDER M LG 40 IN-44 IN ELASTIC,Sx00000084037,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,41.02,36.92,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32,,,32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,20.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,34.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,39.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.15,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.3,,,32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.74,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.92,,,38.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.1,,,20.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32,39.38,
HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID #,Px00030000006,CDM,89060,CPT,300,RC,,,,BOTH,,,41.34,37.21,39.27,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.25,,,32.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.21,,,34.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.21,,,21.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.21,,,34.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.26,,,21.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.21,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,39.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.38,,,32.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.46,,,32.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.03,,,38.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.26,,,21.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,35.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.27,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.21,,,39.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.26,,,20.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.25,39.69,
POLYVINYL ALCOHOL OPHTH SOLN 1.4%,Rx17478006012,CDM,,,250,RC,17478-0060-12,NDC,,BOTH,1,EA,41.55,37.4,39.47,,,39.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.41,,,32.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.36,,,20.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.89,,,39.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.54,,,30.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.56,,,20.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.23,,,38.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.36,,,20.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.32,,,35.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.47,,,39.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.36,,,20.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.41,39.89,
CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%,Rx00023079815,CDM,,,250,RC,00023-0798-15,NDC,,BOTH,1,EA,41.55,37.4,39.47,,,37.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.41,,,32.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,34.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,21.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,34.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.36,,,21.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.89,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.54,,,32.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.56,,,32.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.23,,,38.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.36,,,21.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.32,,,35.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.47,,,37.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,39.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.36,,,20.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.41,39.89,
HC SHOULDER IMMOB - MED-XLARGE,Px00010431WNH,CDM,L3650,CPT,274,RC,,,,BOTH,,,41.58,37.42,39.5,,,37.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.43,,,32.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.42,,,34.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.42,,,21.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.42,,,34.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,21.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.42,,,37.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,39.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.56,,,32.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,32.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.25,,,38.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,21.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.34,,,35.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.5,,,37.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.42,,,39.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.37,,,20.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.43,39.92,
IODINE SOLUTION STRONG 5% (LUGOL'S),Rx48433023015,CDM,,,250,RC,48433-0230-15,NDC,,BOTH,1,EA,41.68,35.83,39.6,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.51,,,32.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,34.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,21.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,34.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.42,,,21.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,37.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.01,,,40.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.63,,,32.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.63,,,32.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.35,,,38.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.42,,,21.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.43,,,35.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,37.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,39.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.42,,,20.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.51,40.01,
HC RIGHT SPOT PH INDICATOR LG 10FR AND GREATER LARGE BORE,Sx0000RS001BX,CDM,,,270,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC RIGHT SPOT PH INDICATOR SMALL 10FR OR LESS SMALL BORE,Sx00RSSB001BX,CDM,,,270,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC COMPRESSION SLEEVE VASOPRESS BLUE MEDIUM CALF,Sx00000VP501M,CDM,,,270,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC CREATININE OTHER SOURCE,Px00030112358,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC CREATININE OTHER SOURCE #,Px00030100592,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC CREATININE OTHER SOURCE #,Px00030100593,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC CREATININE OTHER SOURCE #,Px00030100594,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC CREATININE OTHER SOURCE #,Px00030100595,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC ASSAY CREATININE OTHER SOURCE (RL),Px00031900015,CDM,82570,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC LDH SERUM,Px00030015373,CDM,83615,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC SGPT (ALT),Px00030015931,CDM,84460,CPT,300,RC,,,,BOTH,,,42,37.8,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.76,,,32.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,21.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,34.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.32,,,40.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.87,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,20.79,,,32.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.64,,,38.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,21.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.7,,,35.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.9,,,37.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.8,,,39.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.58,,,20.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.76,40.32,
HC PR ED 36600 WITHDRAWAL OF ARTERIAL BLOOD CDM,Px00098110587,CDM,36600,CPT,981,RC,,,,OUTPATIENT,,,36,32.4,20.16,,,32.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.84,,,28.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,29.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,18.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.5,,,29.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,18.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.61,,,32.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.8,,,34.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,28.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,28.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.52,,,33.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,18.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.52,,,30.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.16,,,32.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,34.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,14.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,14.31,40.5,
PROPARACAINE HCL OPHTH SOLN 0.5%,Rx24208073006,CDM,,,250,RC,24208-0730-06,NDC,,BOTH,1,EA,42.34,38.11,40.22,,,40.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.03,,,33.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.11,,,38.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.11,,,38.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.11,,,38.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.75,,,20.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.11,,,38.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,40.65,,,40.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,31.12,,,31.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,20.95,,,20.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.95,,,38.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.75,,,20.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.99,,,35.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,40.22,,,40.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.11,,,38.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,20.75,,,20.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.03,40.65,
HC PR ED 11720 DEBRIDE NAIL 1-5 CDM,Px00098110250,CDM,11720,CPT,981,RC,,,,OUTPATIENT,,,77,69.3,43.12,,,69.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,20.7,,,60.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.13,,,112.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.13,,,112.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,15.97,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,17.39,,,69.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.35,,,20.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,60.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.89,,,70.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,39.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.89,,,65.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,69.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.95,,,73.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,13.89,,,13.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,13.89,40.95,
HC KCI VAC DRAPE ONLY,Px00011388WNH,CDM,,,270,RC,,,,BOTH,,,42.72,38.45,40.58,,,38.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.45,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.45,,,21.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.45,,,35.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.93,,,21.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.45,,,38.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.4,,,33.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.14,,,33.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.3,,,39.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.93,,,21.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.31,,,36.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.58,,,38.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.45,,,40.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20.93,,,20.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,41.01,
HC ELECTRODE BLADE EXTENDED 6.5 IN MEGADYNE E-Z CLEAN  FT0014,Sx00000000014,CDM,,,270,RC,,,,BOTH,,,42.9,37.48,40.76,,,54.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.46,,,47.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.61,,,50.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.61,,,30.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.61,,,50.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.02,,,30.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.61,,,54.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.18,,,58.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.53,,,47.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.23,,,47.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.47,,,55.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.02,,,30.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.47,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.76,,,54.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.61,,,57.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.02,,,21.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.46,41.18,
HC DRESSING MEDIHONEY 3/4X12 CALCIUM ALGINTE,Sx00000031012,CDM,,,270,RC,,,,BOTH,,,43.28,42.26,41.12,,,38.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.76,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,22.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,36.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.21,,,22.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.55,,,41.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.81,,,33.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.42,,,33.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.82,,,39.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.21,,,22.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.79,,,36.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.12,,,38.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.95,,,41.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.21,,,21.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.76,41.55,
HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION,Px00098310202,CDM,11104,CPT,983,RC,,,,BOTH,,,308,277.2,172.48,,,277.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.86,,,240.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.5,,,275.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.5,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.5,,,275.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.26,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.18,,,277.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.4,,,308,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.44,,,240.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.44,,,240.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.56,,,283.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,156.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.56,,,261.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.48,,,277.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,292.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.44,,,45.44,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,45.44,41.85,
HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC #,Px00030510029,CDM,85025,CPT,300,RC,,,,BOTH,,,43.82,39.44,41.63,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,34.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,22.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,22.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.07,,,42.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.21,,,34.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.69,,,34.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.31,,,40.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,22.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.25,,,37.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.63,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,41.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,21.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.18,42.07,
HC CBC WITH DIFF AUTO,Px00030014514,CDM,85025,CPT,300,RC,,,,BOTH,,,43.82,39.44,41.63,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,34.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,22.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,22.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.07,,,42.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.21,,,34.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.69,,,34.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.31,,,40.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,22.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.25,,,37.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.63,,,39.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.44,,,41.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.47,,,21.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.18,42.07,
HC K WIRE 0.8MM,Sx00000DW1111,CDM,,,270,RC,,,,BOTH,,,43.98,39.58,41.78,,,39.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.3,,,34.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.58,,,36.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.58,,,22.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.58,,,36.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.55,,,22.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.58,,,39.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.22,,,42.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.33,,,34.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.77,,,34.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.46,,,40.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.55,,,22.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.38,,,37.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.78,,,39.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.58,,,41.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.55,,,21.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.3,42.22,
HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN,Px00030112351,CDM,82042,CPT,300,RC,,,,BOTH,,,44,39.6,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.32,,,34.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,22.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.24,,,42.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.78,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.48,,,40.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,41.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,21.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,42.24,
HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN #,Px00030100563,CDM,82042,CPT,300,RC,,,,BOTH,,,44,39.6,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.32,,,34.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,22.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.24,,,42.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.78,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.48,,,40.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,41.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,21.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,42.24,
HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN #,Px00030100777,CDM,82042,CPT,300,RC,,,,BOTH,,,44,39.6,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.32,,,34.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,22.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,36.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.24,,,42.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.78,,,34.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.48,,,40.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,22.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,37.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.8,,,39.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.6,,,41.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.56,,,21.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,42.24,
HC PR 97605 NEG PRESS WOUND TX UTILIZING DME EQUIP < 50SQ CM,Px00096910007,CDM,97605,CPT,983,RC,,,,BOTH,,,58,52.2,32.48,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,45.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,47.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,27.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,47.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.47,,,27.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.1,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.9,,,55.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.89,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.89,,,45.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.06,,,53.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.61,,,27.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.06,,,49.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.48,,,52.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.25,,,55.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.89,,,23.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.89,42.25,
DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV),Rx00536129434,CDM,,,250,RC,00536-1294-34,NDC,,BOTH,1,EA,44.28,32.81,42.07,,,42.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.54,,,34.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.7,,,21.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.51,,,42.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.55,,,32.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21.91,,,21.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.74,,,40.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.7,,,21.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.64,,,37.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.07,,,42.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,21.7,,,21.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.54,42.51,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML (ED PREPACK-OR) PO SOLN,Rx00000005984,CDM,,,250,RC,00000-0059-84,NDC,,BOTH,5,ML,44.35,39.92,42.13,,,65.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.59,,,56.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,60.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,60.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,37.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,65.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.58,,,70.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.6,,,56.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21.95,,,56.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.8,,,67.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,37.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.7,,,62.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.13,,,65.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,69.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.73,,,21.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.59,42.58,
HC CAVILION ADVANCED,Px00012365WNH,CDM,,,270,RC,,,,BOTH,,,44.7,40.23,42.47,,,40.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.87,,,34.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,22.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,37.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.9,,,22.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,40.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.91,,,42.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.85,,,34.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.12,,,34.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.12,,,41.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.9,,,22.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38,,,38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.47,,,40.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,42.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21.9,,,21.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.87,42.91,
HC ASSAY OF TRIGLYCERIDES #,Px00030100771,CDM,84478,CPT,300,RC,,,,BOTH,,,45,40.5,42.75,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,37.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,22.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,37.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,43.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.08,,,35.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.27,,,35.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.25,,,38.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.75,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,42.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,43.2,
HC TRIGLYCERIDES,Px00030016086,CDM,84478,CPT,300,RC,,,,BOTH,,,45,40.5,42.75,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.1,,,35.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,37.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,22.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,37.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,43.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.08,,,35.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.27,,,35.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.25,,,38.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.75,,,40.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.5,,,42.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.05,,,22.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.1,43.2,
HC MEDIHONEY DRESSING 3/4 X 12,Px00012215WNH,CDM,,,270,RC,,,,BOTH,,,45.06,40.55,42.81,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.15,,,35.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.55,,,37.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.55,,,22.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.55,,,37.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,22.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.55,,,40.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.26,,,43.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.12,,,35.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.3,,,35.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.46,,,41.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,22.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.3,,,38.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.81,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.55,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.08,,,22.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.15,43.26,
TERBUTALINE SULFATE 5 MG (ED PREPACK-OR) PO TABS,Rx00000005902,CDM,,,250,RC,00000-0059-02,NDC,,BOTH,5,ME,45.39,40.85,43.12,,,40.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.4,,,35.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,37.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,23.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,37.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.24,,,23.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,40.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.57,,,43.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.36,,,35.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.46,,,35.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.76,,,41.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.24,,,23.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.58,,,38.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,40.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,43.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.24,,,22.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.4,43.57,
HC CULTURE AEROBIC IDENTIFY - CLOTEST,Px00030610366,CDM,87077,CPT,300,RC,,,,BOTH,,,45.57,41.01,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.54,,,35.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,23.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,43.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.49,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.55,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.92,,,41.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.73,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,22.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.54,43.75,
HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE #,Px00030600341,CDM,87086,CPT,300,RC,,,,BOTH,,,45.57,41.01,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.54,,,35.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,23.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,43.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.49,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.55,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.92,,,41.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.73,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,22.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.54,43.75,
HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE #,Px00030600487,CDM,87086,CPT,300,RC,,,,BOTH,,,45.57,41.01,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.54,,,35.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,23.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,37.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.75,,,43.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.49,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.55,,,35.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.92,,,41.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,23.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.73,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.29,,,41.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.01,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.33,,,22.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.54,43.75,
HC STAPLER PROXIMATE 35W 35 STAPLES PER STAPLER DISP,Sx000000PXW35,CDM,,,270,RC,,,,BOTH,,,45.6,32.94,43.32,,,32.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.57,,,28.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.04,,,30.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.04,,,18.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.04,,,30.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.34,,,18.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.04,,,32.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.78,,,35.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.52,,,28.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.57,,,28.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.95,,,33.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.34,,,18.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.76,,,31.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.32,,,32.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.04,,,34.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.34,,,22.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.57,43.78,
HC DRESSING MEDIHONEY 2X2 CALCIUM ALGINTE,Sx00000031022,CDM,,,270,RC,,,,BOTH,,,45.7,41.13,43.42,,,41.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.65,,,35.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.13,,,38.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.13,,,23.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.13,,,38.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.39,,,23.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.13,,,41.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.87,,,43.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.59,,,35.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.62,,,35.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.04,,,42.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.39,,,23.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.85,,,38.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.42,,,41.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.13,,,43.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.39,,,22.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.65,43.87,
HC SPLINT SAM,Px00032310WNH,CDM,,,270,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC ASSAY OF LITHIUM,Px00030112116,CDM,80178,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC URINE ALBUMIN QUANTITATIVE #,Px00030100564,CDM,82043,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC MICROALBUMIN QUANTITATIVE,Px00030112020,CDM,82043,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC ASSAY OF OSMOLALITY BLOOD,Px00030112375,CDM,83930,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC RHEUMATOID FACTOR QUANT,Px00030210522,CDM,86431,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC RHEUMATOID FACTOR QUANTITATIVE #,Px00030200537,CDM,86431,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC RHEUMATOID FACTOR QUANTITATIVE #,Px00030200538,CDM,86431,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC RHEUMATOID FACTOR QUANTITATIVE #,Px00030200539,CDM,86431,CPT,300,RC,,,,BOTH,,,46,41.4,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.88,,,35.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,23.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,38.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.32,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.7,,,41.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.4,,,43.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.88,44.16,
HC CAVILON ADVANCED SKIN PROTECTANT,Sx00000005050,CDM,,,270,RC,,,,BOTH,,,46.01,41.41,43.71,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.89,,,35.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.41,,,38.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.41,,,23.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.41,,,38.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.41,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.17,,,44.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.82,,,35.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.77,,,35.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.33,,,42.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,23.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.11,,,39.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.71,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.41,,,43.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.54,,,22.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.89,44.17,
HC PR 00811 ANES LWR INTST NDSC NOS,Px00096310284,CDM,811,CPT,963,RC,,,,BOTH,,,68,61.2,38.08,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.04,,,57.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,70.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,73.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,70.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.96,,,73.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.96,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.4,,,70.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.72,,,57.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.96,,,57.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.76,,,67.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.3,,,37.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.76,,,62.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.08,,,66.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,70.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,31.96,44.2,BASE FEE
HC SURGICAL DRAIN T-TUBE JACKSON-PRATT SILICONE 19FR,Sx0SU130-1334,CDM,,,270,RC,,,,BOTH,,,46.5,35.64,44.18,,,41.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.27,,,36.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,38.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,23.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,38.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,23.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,41.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.64,,,44.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.18,,,36.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.01,,,36.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,42.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,23.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.53,,,39.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.18,,,41.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.85,,,44.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.79,,,22.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.27,44.64,
HC PR 01965 ANESTH INC/MISSED AB PROC,Px00096310198,CDM,1965,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.17,,,16.17,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01622 ANES DX SHOULDER ARTHROSCOPY,Px00096310158,CDM,1622,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01320 ANESTH KNEE AREA SURGERY,Px00096310127,CDM,1320,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01340 ANESTH KNEE AREA PROCEDURE,Px00096310128,CDM,1340,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01392 ANESTH KNEE AREA SURGERY TIB/FIB/UPPER,Px00096310133,CDM,1392,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01400 ANESTH KNEE AREA SURGERY ARTHROSCOPY,Px00096310134,CDM,1400,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01740 ANESTH UPPER ARM SURGERY,Px00096310171,CDM,1740,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00410 ANESTH CORRECT HEART RHYTHM,Px00096310032,CDM,410,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00702 ANESTH FOR LIVER BIOPSY,Px00096310056,CDM,702,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01484 ANESTH LOWER LEG REVISION,Px00096310149,CDM,1484,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00532 ANESTH VASCULAR ACCESS,Px00096310045,CDM,532,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00942 ANESTH SURG ON VAG/URETHRAL,Px00096310105,CDM,942,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00952 ANESTH HYSTEROSCOPE/GRAPH,Px00096310109,CDM,952,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01966 ANESTH INDUCED AB PROCEDURE,Px00096310235,CDM,1966,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00635 ANESTH LUMBAR PUNCTURE,Px00096310053,CDM,635,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00830 ANESTH REPAIR OF INGUINAL HERNIA,Px00096310072,CDM,830,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00524 ANESTH CHEST DRAINAGE,Px00096310041,CDM,524,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 00750 ANESTH REPAIR OF UPPER HERNIA,Px00096310059,CDM,750,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01202 ANESTH ARTHROSCOPY OF HIP,Px00096310113,CDM,1202,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,64.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01200 ANESTH HIP JOINT PROCEDURE,Px00096310112,CDM,1200,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,62.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,80.84,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC PR 01620 ANESTH SHOULDER PROCEDURE,Px00096310157,CDM,1620,CPT,963,RC,,,,BOTH,,,68.8,61.92,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43,,,71.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,74.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.84,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.15,,,58.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,58.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,68.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,37.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,63.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.53,,,67.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,70.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,80.84,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.34,44.72,BASE FEE
HC DRAPE ORTHO U/SPLIT 6X54 LARGE,Sx00000089311,CDM,,,270,RC,,,,BOTH,,,46.77,42.09,44.43,,,42.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,36.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.09,,,38.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.09,,,23.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.09,,,38.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.92,,,23.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.09,,,42.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.9,,,44.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.38,,,36.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.15,,,36.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.03,,,43.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.92,,,23.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.75,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.43,,,42.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.09,,,44.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.92,,,22.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.48,44.9,
LEVONORGESTREL 1.5 MG (ED PREPACK-OR) PO TABS,Rx00000003641,CDM,,,250,RC,00000-0036-41,NDC,,BOTH,1.5,ME,46.88,42.19,44.54,,,42.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.57,,,36.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,39.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,23.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,39.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.97,,,23.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,42.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.46,,,36.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,36.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.13,,,43.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.97,,,23.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,39.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,42.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,44.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22.97,,,22.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.57,45,
HC BINDER ABD 30 IN-45 IN SM 410 30 IN TO 45 IN 9 IN 3 PANEL,Sx00079-89090,CDM,,,270,RC,,,,BOTH,,,46.97,42.27,44.62,,,42.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.64,,,36.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.27,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.27,,,23.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.27,,,39.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.02,,,23.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.27,,,42.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.09,,,45.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.52,,,36.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.25,,,36.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.21,,,43.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.02,,,23.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.92,,,39.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.62,,,42.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.27,,,44.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.02,,,23.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.64,45.09,
HC ASSAY OF MAGNESIUM #,Px00030015863,CDM,83735,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC OSMOLALITY URINE,Px00030112044,CDM,83935,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC BLOOD COUNT COMPLETE AUTOMATED #,Px00030500144,CDM,85027,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC BLOOD COUNT COMPLETE AUTOMATED #,Px00030500145,CDM,85027,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC BLOOD COUNT COMPLETE AUTOMATED,Px00030500146,CDM,85027,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC BLOOD COUNT COMPLETE AUTOMATED #,Px00030500147,CDM,85027,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC BLOOD COUNT COMPLETE AUTOMATED,Px00030014447,CDM,85027,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC THROMBOPLASTIN TIME PARTIAL,Px00030510033,CDM,85730,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD #,Px00030500168,CDM,85730,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD #,Px00030500169,CDM,85730,CPT,300,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC VASOPNEUMATIC DEVICE THERAPY,Px00042010114,CDM,97016,CPT,420,RC,,,,BOTH,,,47,42.3,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.66,,,36.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,23.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,39.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.12,,,45.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.55,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,36.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.24,,,43.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,39.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,44.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.03,,,23.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.66,45.12,
HC COMPRESSION SLEEVE VASOPRESS BLUE LARGE CALF,Sx00000VP501L,CDM,,,270,RC,,,,BOTH,,,47.34,42.61,44.97,,,42.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.93,,,36.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,39.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,24.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,39.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,24.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,42.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.45,,,45.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.43,,,36.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.55,,,43.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,24.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.24,,,40.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.97,,,42.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,44.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.2,,,23.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.93,45.45,
HC PR ED 99151 MOD SED SAME PHYS/QHP <5YRS 1ST 15 MIN CDM,Px00098110144,CDM,99151,CPT,981,RC,,,,OUTPATIENT,,,60,54,33.6,,,54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.51,,,46.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.5,,,49.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.5,,,30.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.5,,,49.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.59,,,30.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.93,,,54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33,,,57.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.12,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.12,,,46.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,55.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.81,,,30.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.2,,,51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.6,,,54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.5,,,57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.12,,,23.12,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.12,45.5,
HC COLLAR CERVICAL - MED/LARGE,Px00000240WNH,CDM,L0120,CPT,274,RC,,,,BOTH,,,47.46,42.71,45.09,,,42.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.02,,,37.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,39.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,24.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,39.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,24.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,42.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.56,,,45.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.88,,,37.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,37.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.66,,,43.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,24.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.34,,,40.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.09,,,42.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,45.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.26,,,23.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.02,45.56,
GATIFLOXACIN OPHTH SOLN 0.5%,Rx61314067225,CDM,,,250,RC,61314-0672-25,NDC,,BOTH,1,EA,47.51,41.77,45.13,,,45.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.06,,,37.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.28,,,23.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.61,,,45.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.92,,,34.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,23.51,,,23.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.71,,,43.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.28,,,23.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.38,,,40.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.13,,,45.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.28,,,23.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.06,45.61,
HC DISPOSABLE CAUTERY PEN - F TIP,Px00001287WNH,CDM,,,270,RC,,,,BOTH,,,47.94,43.15,45.54,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.39,,,37.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,39.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,24.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,39.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,24.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.02,,,46.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.24,,,37.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.73,,,37.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,24.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.75,,,40.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.54,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,23.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.39,46.02,
HC DISPOSABLE CAUTERY PEN,Px00000888WNH,CDM,,,270,RC,,,,BOTH,,,47.94,43.15,45.54,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.39,,,37.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,39.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,24.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,39.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,24.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.02,,,46.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.24,,,37.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.73,,,37.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,24.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.75,,,40.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.54,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.49,,,23.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.39,46.02,
AZITHROMYCIN 250 MG (ED PREPACK-OR) PO TABS,Rx00000003071,CDM,,,250,RC,00000-0030-71,NDC,,BOTH,250,ME,48,43.2,45.6,,,43.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.44,,,37.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,39.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,24.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,39.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,43.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.08,,,46.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,37.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.76,,,37.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.16,,,44.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,24.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.8,,,40.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.6,,,43.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,45.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.52,,,23.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.44,46.08,
HC BAG BILE REG 19OZ T TUBES 12FR-20FR,Sx00000015850,CDM,,,270,RC,,,,BOTH,,,48.3,43.47,45.89,,,43.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.67,,,37.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.47,,,40.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.47,,,24.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.47,,,40.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.67,,,24.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.47,,,43.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.5,,,37.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.9,,,37.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.44,,,44.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.67,,,24.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.06,,,41.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.89,,,43.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.47,,,45.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.67,,,23.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.67,46.37,
TIOTROPIUM BROMIDE MONOHYDRATE INHAL AEROSOL 2.5 MCG/ACT,Rx00597010051,CDM,,,250,RC,00597-0100-51,NDC,,BOTH,0.0025,ME,48.59,43.75,46.16,,,46.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.9,,,37.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.81,,,23.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.65,,,46.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.71,,,35.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.05,,,24.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.7,,,44.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.81,,,23.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.3,,,41.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.16,,,46.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.81,,,23.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.9,46.65,
PILOCARPINE HCL OPHTH SOLN 2%,Rx61314020415,CDM,,,250,RC,61314-0204-15,NDC,,BOTH,1,EA,48.71,42.91,46.27,,,46.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.99,,,37.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.84,,,43.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.84,,,43.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.84,,,43.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.87,,,23.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.84,,,43.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.76,,,46.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.8,,,35.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.11,,,24.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.81,,,44.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.87,,,23.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.4,,,41.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.27,,,46.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.84,,,43.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,23.87,,,23.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.99,46.76,
PILOCARPINE HCL OPHTH SOLN 2%,Rx70069019101,CDM,,,250,RC,70069-0191-01,NDC,,BOTH,1,EA,48.9,44.04,46.46,,,44.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.14,,,38.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.01,,,40.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.01,,,24.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.01,,,40.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.96,,,24.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.01,,,44.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.94,,,46.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,38.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.2,,,38.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.99,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.96,,,24.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,41.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.46,,,44.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.01,,,46.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,23.96,,,23.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.14,46.94,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx72266011825,CDM,J1885,HCPCS,636,RC,72266011825,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx72485010101,CDM,J1200,HCPCS,636,RC,72485010101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx72485010125,CDM,J1200,HCPCS,636,RC,72485010125,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx72611072201,CDM,J1885,HCPCS,636,RC,72611072201,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx72611072225,CDM,J1885,HCPCS,636,RC,72611072225,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx72611074101,CDM,J2250,HCPCS,636,RC,72611074101,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx72611076501,CDM,J3370,HCPCS,636,RC,72611076501,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIAZEPAM INJ 5 MG/ML,Rx76045020400,CDM,J3360,HCPCS,636,RC,76045020400,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)",Rx76329333901,CDM,J0461,HCPCS,636,RC,76329333901,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)",Rx76329334001,CDM,J0461,HCPCS,636,RC,76329334001,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx81284015200,CDM,J2543,HCPCS,636,RC,81284015200,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx81284015210,CDM,J2543,HCPCS,636,RC,81284015210,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML",Rx00000000338,CDM,J2270,HCPCS,636,RC,338,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),Rx00008092351,CDM,C9113,HCPCS,636,RC,8092351,NDC,,BOTH,40,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),Rx00008400110,CDM,C9113,HCPCS,636,RC,8400110,NDC,,BOTH,40,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV),Rx00009003906,CDM,J2920,HCPCS,636,RC,9003906,NDC,,BOTH,40,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV),Rx00009004703,CDM,J2930,HCPCS,636,RC,9004703,NDC,,BOTH,125,ME,49,44.16,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV),Rx00009004725,CDM,J2930,HCPCS,636,RC,9004725,NDC,,BOTH,125,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML,Rx00009307301,CDM,J1030,HCPCS,636,RC,9307301,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML,Rx00009307303,CDM,J1030,HCPCS,636,RC,9307303,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx00069020901,CDM,J2704,HCPCS,636,RC,69020901,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML,Rx00085432001,CDM,J0702,HCPCS,636,RC,85432001,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),Rx00143967301,CDM,J1953,HCPCS,636,RC,143967301,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,Rx00143972101,CDM,J1956,HCPCS,636,RC,143972101,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TERBUTALINE SULFATE INJ 1 MG/ML,Rx00143974610,CDM,J3105,HCPCS,636,RC,143974610,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML),Rx00143978410,CDM,J3490,HCPCS,636,RC,143978410,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),Rx00143987525,CDM,J0282,HCPCS,636,RC,143987525,NDC,,BOTH,3,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx00338007225,CDM,J1885,HCPCS,636,RC,338007225,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
POTASSIUM CHLORIDE INJ 10 MEQ/100ML,Rx00338070948,CDM,J3480,HCPCS,636,RC,338070948,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,Rx00409115919,CDM,J0665,HCPCS,636,RC,409115919,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,Rx00409116219,CDM,J0665,HCPCS,636,RC,409116219,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%)",Rx00409132305,CDM,J2001,HCPCS,636,RC,409132305,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MEROPENEM IV FOR SOLN 1 GM,Rx00409139121,CDM,J2185,HCPCS,636,RC,409139121,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALBUPHINE HCL INJ 10 MG/ML,Rx00409146371,CDM,J2300,HCPCS,636,RC,409146371,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETAMINE HCL INJ 100 MG/ML,Rx00409205115,CDM,J3490,HCPCS,636,RC,409205115,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)",Rx00409230822,CDM,J2250,HCPCS,636,RC,409230822,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DOBUTAMINE HCL INJ 12.5 MG/ML,Rx00409234462,CDM,J1250,HCPCS,636,RC,409234462,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,Rx00409272130,CDM,J1644,HCPCS,636,RC,409272130,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CIPROFLOXACIN 400 MG/200ML IN D5W,Rx00409330001,CDM,J0744,HCPCS,636,RC,409330001,NDC,,BOTH,400,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDROMORPHONE HCL INJ 2 MG/ML,Rx00409336511,CDM,J1170,HCPCS,636,RC,409336511,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),Rx00409341418,CDM,J2765,HCPCS,636,RC,409341418,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MANNITOL IV SOLN 25%,Rx00409403116,CDM,J2150,HCPCS,636,RC,409403116,NDC,,BOTH,50,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx00409469930,CDM,J2704,HCPCS,636,RC,409469930,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx00409469930,CDM,J2704,HCPCS,636,RC,409469930,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx00409469930,CDM,J2704,HCPCS,636,RC,409469930,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx00409469950,CDM,J2704,HCPCS,636,RC,409469950,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx00409469950,CDM,J2704,HCPCS,636,RC,409469950,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx00409469950,CDM,J2704,HCPCS,636,RC,409469950,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CIPROFLOXACIN 400 MG/200ML IN D5W,Rx00409477702,CDM,J0744,HCPCS,636,RC,409477702,NDC,,BOTH,400,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)",Rx00409491111,CDM,J0461,HCPCS,636,RC,409491111,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),Rx00409525502,CDM,J2765,HCPCS,636,RC,409525502,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx00409601002,CDM,J2704,HCPCS,636,RC,409601002,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx00409653311,CDM,J3370,HCPCS,636,RC,409653311,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 2 GM,Rx00409733503,CDM,J0696,HCPCS,636,RC,409733503,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 2 GM,Rx00409733513,CDM,J0696,HCPCS,636,RC,409733513,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 500 MG,Rx00409733811,CDM,J0696,HCPCS,636,RC,409733811,NDC,,BOTH,500,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DOPAMINE INJ 1.6 MG/ML IN D5W,Rx00409780911,CDM,J1265,HCPCS,636,RC,409780911,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,Rx00409909337,CDM,J3010,HCPCS,636,RC,409909337,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",Rx00409909337,CDM,J3010,HCPCS,636,RC,409909337,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,Rx00409909412,CDM,J3010,HCPCS,636,RC,409909412,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHYTONADIONE INJ 10 MG/ML,Rx00409915850,CDM,J3430,HCPCS,636,RC,409915850,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML",Rx00517040125,CDM,J0461,HCPCS,636,RC,517040125,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDRALAZINE HCL INJ 20 MG/ML,Rx00517090101,CDM,J0360,HCPCS,636,RC,517090101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML),Rx00517460225,CDM,J1596,HCPCS,636,RC,517460225,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx00641037621,CDM,J1200,HCPCS,636,RC,641037621,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIGOXIN INJ 0.25 MG/ML,Rx00641141035,CDM,J1160,HCPCS,636,RC,641141035,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,Rx00641602701,CDM,J3010,HCPCS,636,RC,641602701,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,Rx00641602725,CDM,J3010,HCPCS,636,RC,641602725,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LORAZEPAM INJ 2 MG/ML,Rx00641604401,CDM,J2060,HCPCS,636,RC,641604401,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx00641613201,CDM,J2310,HCPCS,636,RC,641613201,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",Rx00641613201,CDM,J2310,HCPCS,636,RC,641613201,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx00641613225,CDM,J2310,HCPCS,636,RC,641613225,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML),Rx00641614901,CDM,J2710,HCPCS,636,RC,641614901,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LORAZEPAM INJ 2 MG/ML,Rx00641620725,CDM,J2060,HCPCS,636,RC,641620725,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROMETHAZINE HCL INJ 25 MG/ML,Rx00641620825,CDM,J2550,HCPCS,636,RC,641620825,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),Rx00703450201,CDM,J2765,HCPCS,636,RC,703450201,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),Rx00703450204,CDM,J2765,HCPCS,636,RC,703450204,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx00781315606,CDM,J0131,HCPCS,636,RC,781315606,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx00781315695,CDM,J0131,HCPCS,636,RC,781315695,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 2 GM,Rx00781320990,CDM,J0696,HCPCS,636,RC,781320990,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HALOPERIDOL LACTATE INJ 5 MG/ML,Rx10147091101,CDM,J1630,HCPCS,636,RC,10147091101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,Rx17478003002,CDM,J3010,HCPCS,636,RC,17478003002,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",Rx17478003002,CDM,J3010,HCPCS,636,RC,17478003002,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,Rx17478003005,CDM,J3010,HCPCS,636,RC,17478003005,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",Rx17478003005,CDM,J3010,HCPCS,636,RC,17478003005,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ALFENTANIL HCL IV SOLN 1000 MCG/2ML (500 MCG/ML) (BASE EQ),ALFENTANIL HCL IV SOLN 2500 MCG/5ML (500 MCG/ML) (BASE EQ)",Rx17478006702,CDM,J0216,HCPCS,636,RC,17478006702,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)",Rx17478052410,CDM,J2250,HCPCS,636,RC,17478052410,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ADENOSINE IV SOLN 6 MG/2ML,Rx17478054202,CDM,J0153,HCPCS,636,RC,17478054202,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ADENOSINE IV SOLN 6 MG/2ML,Rx17478054225,CDM,J0153,HCPCS,636,RC,17478054225,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),Rx23155024031,CDM,J2765,HCPCS,636,RC,23155024031,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx23155047333,CDM,J1940,HCPCS,636,RC,23155047333,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),Rx23155054831,CDM,J2405,HCPCS,636,RC,23155054831,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx23155060031,CDM,J2250,HCPCS,636,RC,23155060031,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx24201010001,CDM,J0131,HCPCS,636,RC,24201010001,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFAZOLIN SODIUM FOR INJ 1 GM,Rx25021010167,CDM,J0690,HCPCS,636,RC,25021010167,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFOXITIN SODIUM FOR IV SOLN 2 GM,Rx25021011020,CDM,J0694,HCPCS,636,RC,25021011020,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ADENOSINE IV SOLN 6 MG/2ML,Rx25021031802,CDM,J0153,HCPCS,636,RC,25021031802,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx25021060820,CDM,J2704,HCPCS,636,RC,25021060820,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx25021060820,CDM,J2704,HCPCS,636,RC,25021060820,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx25021060820,CDM,J2704,HCPCS,636,RC,25021060820,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CIPROFLOXACIN 200 MG/100ML IN D5W,Rx36000000824,CDM,J0744,HCPCS,636,RC,36000000824,NDC,,BOTH,200,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,Rx36000004824,CDM,J1956,HCPCS,636,RC,36000004824,NDC,,BOTH,150,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML),Rx36000014801,CDM,J3490,HCPCS,636,RC,36000014801,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx36000028425,CDM,J1940,HCPCS,636,RC,36000028425,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,Rx36000029524,CDM,J1956,HCPCS,636,RC,36000029524,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETAMINE HCL INJ 100 MG/ML,Rx42023011510,CDM,J3490,HCPCS,636,RC,42023011510,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT),Rx43598006111,CDM,J3486,HCPCS,636,RC,43598006111,NDC,,BOTH,20,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT),Rx43598006158,CDM,J3486,HCPCS,636,RC,43598006158,NDC,,BOTH,20,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx43598026520,CDM,J2704,HCPCS,636,RC,43598026520,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx43598026520,CDM,J2704,HCPCS,636,RC,43598026520,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx43598026520,CDM,J2704,HCPCS,636,RC,43598026520,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx43598026558,CDM,J2704,HCPCS,636,RC,43598026558,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx43598026558,CDM,J2704,HCPCS,636,RC,43598026558,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx43598026558,CDM,J2704,HCPCS,636,RC,43598026558,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHYTONADIONE INJ 10 MG/ML,Rx43598040511,CDM,J3430,HCPCS,636,RC,43598040511,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT),Rx43598084811,CDM,J3486,HCPCS,636,RC,43598084811,NDC,,BOTH,20,ME,49,121.17,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTAZIDIME FOR IV SOLN 2 GM,Rx44567023610,CDM,J0713,HCPCS,636,RC,44567023610,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT,Rx44567031110,CDM,J2540,HCPCS,636,RC,44567031110,NDC,,BOTH,5000000,UN,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFAZOLIN SODIUM FOR INJ 1 GM,Rx44567070725,CDM,J0690,HCPCS,636,RC,44567070725,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),Rx51224001301,CDM,J1953,HCPCS,636,RC,51224001301,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM BICARBONATE IV SOLN 8.4%,Rx51754500101,CDM,J7999,HCPCS,636,RC,51754500101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,Rx55150017030,CDM,J0665,HCPCS,636,RC,55150017030,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML,Rx55150017301,CDM,J3030,HCPCS,636,RC,55150017301,NDC,,BOTH,0.5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),Rx55150020200,CDM,C9113,HCPCS,636,RC,55150020200,NDC,,BOTH,40,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHOCARBAMOL INJ 1000 MG/10ML,Rx55150022310,CDM,J2800,HCPCS,636,RC,55150022310,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx55150030701,CDM,J0131,HCPCS,636,RC,55150030701,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx55150032425,CDM,J1940,HCPCS,636,RC,55150032425,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),Rx60505613000,CDM,J2405,HCPCS,636,RC,60505613000,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),Rx60505613005,CDM,J2405,HCPCS,636,RC,60505613005,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFAZOLIN SODIUM FOR INJ 1 GM,Rx60505614200,CDM,J0690,HCPCS,636,RC,60505614200,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 1 GM,Rx60505614804,CDM,J0696,HCPCS,636,RC,60505614804,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx60505615700,CDM,J2543,HCPCS,636,RC,60505615700,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx60505615704,CDM,J2543,HCPCS,636,RC,60505615704,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx61990012001,CDM,J2543,HCPCS,636,RC,61990012001,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
THIAMINE HCL INJ 100 MG/ML,Rx63323001301,CDM,J3411,HCPCS,636,RC,63323001301,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
THIAMINE HCL INJ 100 MG/ML,Rx63323001326,CDM,J3411,HCPCS,636,RC,63323001326,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
THIAMINE HCL INJ 100 MG/ML,Rx63323001341,CDM,J3411,HCPCS,636,RC,63323001341,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CYANOCOBALAMIN INJ 1000 MCG/ML,Rx63323004441,CDM,J3420,HCPCS,636,RC,63323004441,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE INJ 50%,Rx63323006403,CDM,J3475,HCPCS,636,RC,63323006403,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE INJ 50%,Rx63323006404,CDM,J3475,HCPCS,636,RC,63323006404,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE INJ 50%,Rx63323006411,CDM,J3475,HCPCS,636,RC,63323006411,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE INJ 50%,Rx63323006443,CDM,J3475,HCPCS,636,RC,63323006443,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML),Rx63323010600,CDM,J3475,HCPCS,636,RC,63323010600,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx63323016200,CDM,J1885,HCPCS,636,RC,63323016200,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx63323016216,CDM,J1885,HCPCS,636,RC,63323016216,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROTAMINE SULFATE INJ 10 MG/ML,Rx63323022930,CDM,J2720,HCPCS,636,RC,63323022930,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx63323026929,CDM,J2704,HCPCS,636,RC,63323026929,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx63323026929,CDM,J2704,HCPCS,636,RC,63323026929,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx63323026929,CDM,J2704,HCPCS,636,RC,63323026929,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),Rx63323026994,CDM,J2704,HCPCS,636,RC,63323026994,NDC,,BOTH,20,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx63323026994,CDM,J2704,HCPCS,636,RC,63323026994,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",Rx63323026994,CDM,J2704,HCPCS,636,RC,63323026994,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML,Rx63323027301,CDM,J3030,HCPCS,636,RC,63323027301,NDC,,BOTH,0.5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx63323028005,CDM,J1940,HCPCS,636,RC,63323028005,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx63323028010,CDM,J1940,HCPCS,636,RC,63323028010,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx63323028036,CDM,J1940,HCPCS,636,RC,63323028036,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx63323028401,CDM,J3370,HCPCS,636,RC,63323028401,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx63323028441,CDM,J3370,HCPCS,636,RC,63323028441,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx63323028442,CDM,J3370,HCPCS,636,RC,63323028442,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROPIVACAINE HCL INJ 5 MG/ML,Rx63323028620,CDM,J2795,HCPCS,636,RC,63323028620,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML),Rx63323037700,CDM,J2354,HCPCS,636,RC,63323037700,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML),Rx63323037701,CDM,J2354,HCPCS,636,RC,63323037701,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML),Rx63323037741,CDM,J2354,HCPCS,636,RC,63323037741,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AZITHROMYCIN IV FOR SOLN 500 MG,Rx63323039801,CDM,J0456,HCPCS,636,RC,63323039801,NDC,,BOTH,500,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),Rx63323040005,CDM,J1953,HCPCS,636,RC,63323040005,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),Rx63323040044,CDM,J1953,HCPCS,636,RC,63323040044,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx63323041115,CDM,J2250,HCPCS,636,RC,63323041115,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,Rx63323046402,CDM,J0665,HCPCS,636,RC,63323046402,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,Rx63323046437,CDM,J0665,HCPCS,636,RC,63323046437,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,Rx63323046601,CDM,J0665,HCPCS,636,RC,63323046601,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,Rx63323050601,CDM,J1100,HCPCS,636,RC,63323050601,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,Rx63323050641,CDM,J1100,HCPCS,636,RC,63323050641,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML),Rx63323057812,CDM,J1596,HCPCS,636,RC,63323057812,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPRANOLOL HCL INJ 1 MG/ML,Rx63323060400,CDM,J1800,HCPCS,636,RC,63323060400,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPRANOLOL HCL INJ 1 MG/ML,Rx63323060401,CDM,J1800,HCPCS,636,RC,63323060401,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),Rx63323061601,CDM,J0282,HCPCS,636,RC,63323061601,NDC,,BOTH,3,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),Rx63323061603,CDM,J0282,HCPCS,636,RC,63323061603,NDC,,BOTH,3,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx63323066400,CDM,J1200,HCPCS,636,RC,63323066400,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx63323066401,CDM,J1200,HCPCS,636,RC,63323066401,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx63323066441,CDM,J1200,HCPCS,636,RC,63323066441,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,Rx63323080613,CDM,J3010,HCPCS,636,RC,63323080613,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx63323098321,CDM,J2543,HCPCS,636,RC,63323098321,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx63323098323,CDM,J2543,HCPCS,636,RC,63323098323,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML,Rx64253033335,CDM,J1642,HCPCS,636,RC,64253033335,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),Rx65219043301,CDM,C9113,HCPCS,636,RC,65219043301,NDC,,BOTH,40,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),Rx67457015303,CDM,J0282,HCPCS,636,RC,67457015303,NDC,,BOTH,3,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDRALAZINE HCL INJ 20 MG/ML,Rx67457029100,CDM,J0360,HCPCS,636,RC,67457029100,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx67457034000,CDM,J3370,HCPCS,636,RC,67457034000,NDC,,BOTH,1,ME,49,90.32,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx67457059902,CDM,J2310,HCPCS,636,RC,67457059902,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,Rx67457060299,CDM,J1644,HCPCS,636,RC,67457060299,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ADENOSINE IV SOLN 6 MG/2ML,Rx67457085500,CDM,J0153,HCPCS,636,RC,67457085500,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ADENOSINE IV SOLN 6 MG/2ML,Rx67457085502,CDM,J0153,HCPCS,636,RC,67457085502,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AZITHROMYCIN IV FOR SOLN 500 MG,Rx67457086000,CDM,J0456,HCPCS,636,RC,67457086000,NDC,,BOTH,500,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AZITHROMYCIN IV FOR SOLN 500 MG,Rx67457086050,CDM,J0456,HCPCS,636,RC,67457086050,NDC,,BOTH,500,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,Rx69918070003,CDM,J0330,HCPCS,636,RC,69918070003,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CYANOCOBALAMIN INJ 1000 MCG/ML,Rx70069000501,CDM,J3420,HCPCS,636,RC,70069000501,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CYANOCOBALAMIN INJ 1000 MCG/ML,Rx70069000510,CDM,J3420,HCPCS,636,RC,70069000510,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,Rx70069002101,CDM,J1100,HCPCS,636,RC,70069002101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx70069007101,CDM,J2310,HCPCS,636,RC,70069007101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx70069007110,CDM,J2310,HCPCS,636,RC,70069007110,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHOCARBAMOL INJ 1000 MG/10ML,Rx70069010101,CDM,J2800,HCPCS,636,RC,70069010101,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,Rx70069030101,CDM,J0330,HCPCS,636,RC,70069030101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHENYLEPHRINE HCL IV SOLN 10 MG/ML,Rx70069080101,CDM,J2371,HCPCS,636,RC,70069080101,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML,Rx70121104902,CDM,J3301,HCPCS,636,RC,70121104902,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML,Rx70121157305,CDM,J1030,HCPCS,636,RC,70121157305,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML,Rx70121165701,CDM,J3301,HCPCS,636,RC,70121165701,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AZITHROMYCIN IV FOR SOLN 500 MG,Rx70436001982,CDM,J0456,HCPCS,636,RC,70436001982,NDC,,BOTH,500,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),Rx70860010541,CDM,J3370,HCPCS,636,RC,70860010541,NDC,,BOTH,1,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML),Rx70860030141,CDM,J7999,HCPCS,636,RC,70860030141,NDC,,BOTH,25,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx70860060002,CDM,J2250,HCPCS,636,RC,70860060002,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx70860060041,CDM,J2250,HCPCS,636,RC,70860060041,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,Rx71288040401,CDM,J1644,HCPCS,636,RC,71288040401,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,Rx71288040402,CDM,J1644,HCPCS,636,RC,71288040402,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,Rx71288042095,CDM,J1644,HCPCS,636,RC,71288042095,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHOCARBAMOL INJ 1000 MG/10ML,Rx71288071610,CDM,J2800,HCPCS,636,RC,71288071610,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHENYLEPHRINE HCL IV SOLN 10 MG/ML,Rx71288080701,CDM,J2371,HCPCS,636,RC,71288080701,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx72266011801,CDM,J1885,HCPCS,636,RC,72266011801,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx00143923401,CDM,,,250,RC,00143-9234-01,NDC,,BOTH,10,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx00143923410,CDM,,,250,RC,00143-9234-10,NDC,,BOTH,10,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx00143925001,CDM,,,250,RC,00143-9250-01,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx00143932001,CDM,,,250,RC,00143-9320-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ETOMIDATE IV SOLN 2 MG/ML,Rx00143950601,CDM,,,250,RC,00143-9506-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML,Rx00143953201,CDM,,,250,RC,00143-9532-01,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML,Rx00143953225,CDM,,,250,RC,00143-9532-25,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx00143957501,CDM,,,250,RC,00143-9575-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx00143957510,CDM,,,250,RC,00143-9575-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx00143962201,CDM,,,250,RC,00143-9622-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ENALAPRILAT IV INJ 1.25 MG/ML,Rx00143978610,CDM,,,250,RC,00143-9786-10,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ENALAPRILAT IV INJ 1.25 MG/ML,Rx00143978701,CDM,,,250,RC,00143-9787-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ENALAPRILAT IV INJ 1.25 MG/ML,Rx00143978710,CDM,,,250,RC,00143-9787-10,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METRONIDAZOLE IV SOLN 500 MG/100ML,Rx00338954124,CDM,,,250,RC,00338-9541-24,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CALCIUM CHLORIDE INJ 10%,Rx00409163140,CDM,,,250,RC,00409-1631-40,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",Rx00409177815,CDM,,,250,RC,00409-1778-15,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,Rx00409317816,CDM,,,250,RC,00409-3178-16,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx00409427616,CDM,,,250,RC,00409-4276-16,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx00409427716,CDM,,,250,RC,00409-4277-16,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx00409488717,CDM,,,250,RC,00409-4887-17,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx00409488723,CDM,,,250,RC,00409-4887-23,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,Rx00409488802,CDM,,,250,RC,00409-4888-02,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",Rx00409492120,CDM,,,250,RC,00409-4921-20,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",Rx00409493311,CDM,,,250,RC,00409-4933-11,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM BICARBONATE IV SOLN 8.4%,Rx00409662502,CDM,,,250,RC,00409-6625-02,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM BICARBONATE IV SOLN 8.4%,Rx00409662522,CDM,,,250,RC,00409-6625-22,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM BICARBONATE IV SOLN 8.4%,Rx00409663724,CDM,,,250,RC,00409-6637-24,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ETOMIDATE IV SOLN 2 MG/ML,Rx00409669511,CDM,,,250,RC,00409-6695-11,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx00409955805,CDM,,,250,RC,00409-9558-05,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML),Rx00641601510,CDM,,,250,RC,00641-6015-10,NDC,,BOTH,25,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx00641614701,CDM,,,250,RC,00641-6147-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx00641614710,CDM,,,250,RC,00641-6147-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx00703291401,CDM,,,250,RC,00703-2914-01,NDC,,BOTH,10,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML,Rx00781329091,CDM,,,250,RC,00781-3290-91,NDC,,BOTH,50,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML,Rx25021011506,CDM,,,250,RC,25021-0115-06,NDC,,BOTH,6,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METRONIDAZOLE IV SOLN 500 MG/100ML,Rx25021013182,CDM,,,250,RC,25021-0131-82,NDC,,BOTH,100,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx25021031720,CDM,,,250,RC,25021-0317-20,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",Rx36000003310,CDM,,,250,RC,36000-0033-10,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),Rx36000016201,CDM,,,250,RC,36000-0162-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),Rx36000016210,CDM,,,250,RC,36000-0162-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx36000032202,CDM,,,250,RC,36000-0322-02,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FOLIC ACID INJ 5 MG/ML,Rx39822110001,CDM,,,250,RC,39822-1100-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx39822420001,CDM,,,250,RC,39822-4200-01,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx39822420002,CDM,,,250,RC,39822-4200-02,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML",Rx42023016801,CDM,,,250,RC,42023-0168-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML",Rx42023016889,CDM,,,250,RC,42023-0168-89,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION),Rx42023019001,CDM,,,250,RC,42023-0190-01,NDC,,BOTH,1,ML,49,111.45,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx42023021601,CDM,,,250,RC,42023-0216-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx42023021683,CDM,,,250,RC,42023-0216-83,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx42023021689,CDM,,,250,RC,42023-0216-89,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ENALAPRILAT IV INJ 1.25 MG/ML,Rx43598016911,CDM,,,250,RC,43598-0169-11,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NAFCILLIN SODIUM FOR INJ 2 GM,Rx44567022210,CDM,,,250,RC,44567-0222-10,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx47335093140,CDM,,,250,RC,47335-0931-40,NDC,,BOTH,10,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx50242090124,CDM,,,250,RC,50242-0901-24,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML",Rx54288010301,CDM,,,250,RC,54288-0103-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML",Rx54288010310,CDM,,,250,RC,54288-0103-10,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MULTIPLE VITAMIN INJ,Rx54643564901,CDM,,,250,RC,54643-5649-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NAFCILLIN SODIUM FOR INJ 2 GM,Rx55150012315,CDM,,,250,RC,55150-0123-15,NDC,,BOTH,2,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,Rx55150016505,CDM,,,250,RC,55150-0165-05,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ESMOLOL HCL INJ 100 MG/10ML,Rx55150019410,CDM,,,250,RC,55150-0194-10,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx55150025110,CDM,,,250,RC,55150-0251-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx55150025220,CDM,,,250,RC,55150-0252-20,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx55150025520,CDM,,,250,RC,55150-0255-20,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx63323018508,CDM,,,250,RC,63323-0185-08,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,Rx63323018601,CDM,,,250,RC,63323-0186-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,Rx63323018603,CDM,,,250,RC,63323-0186-03,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,Rx63323020805,CDM,,,250,RC,63323-0208-05,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CALCIUM GLUCONATE INJ 10%,Rx63323036019,CDM,,,250,RC,63323-0360-19,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
POLYMYXIN B SULFATE FOR INJ 500000 UNIT,Rx63323036741,CDM,,,250,RC,63323-0367-41,NDC,,BOTH,500000,UN,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFOTETAN DISODIUM FOR INJ 1 GM,Rx63323038501,CDM,,,250,RC,63323-0385-01,NDC,,BOTH,1,GR,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx63323042602,CDM,,,250,RC,63323-0426-02,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx63323042605,CDM,,,250,RC,63323-0426-05,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF),Rx63323046802,CDM,,,250,RC,63323-0468-02,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,Rx63323048203,CDM,,,250,RC,63323-0482-03,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,Rx63323048241,CDM,,,250,RC,63323-0482-41,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000,Rx63323048357,CDM,,,250,RC,63323-0483-57,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx63323048501,CDM,,,250,RC,63323-0485-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx63323048526,CDM,,,250,RC,63323-0485-26,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx63323048541,CDM,,,250,RC,63323-0485-41,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx63323048557,CDM,,,250,RC,63323-0485-57,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx63323048602,CDM,,,250,RC,63323-0486-02,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx63323048605,CDM,,,250,RC,63323-0486-05,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx63323048626,CDM,,,250,RC,63323-0486-26,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,Rx63323049207,CDM,,,250,RC,63323-0492-07,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,Rx63323049216,CDM,,,250,RC,63323-0492-16,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,Rx63323049245,CDM,,,250,RC,63323-0492-45,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VALPROATE SODIUM INJ 100 MG/ML,Rx63323049401,CDM,,,250,RC,63323-0494-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VALPROATE SODIUM INJ 100 MG/ML,Rx63323049441,CDM,,,250,RC,63323-0494-41,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML,Rx63323073941,CDM,,,250,RC,63323-0739-41,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx63323078121,CDM,,,250,RC,63323-0781-21,NDC,,BOTH,10,ME,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),Rx63323094004,CDM,,,250,RC,63323-0940-04,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),Rx63323094021,CDM,,,250,RC,63323-0940-21,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx63833076140,CDM,,,250,RC,63833-0761-40,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx65219025700,CDM,,,250,RC,65219-0257-00,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)",Rx67457022800,CDM,,,250,RC,67457-0228-00,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx67457022800,CDM,,,250,RC,67457-0228-00,NDC,,BOTH,5,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML,Rx67457043300,CDM,,,250,RC,67457-0433-00,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML,Rx67457043322,CDM,,,250,RC,67457-0433-22,NDC,,BOTH,2,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ETOMIDATE IV SOLN 2 MG/ML,Rx67457090200,CDM,,,250,RC,67457-0902-00,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx70121163701,CDM,,,250,RC,70121-1637-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx70121163707,CDM,,,250,RC,70121-1637-07,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ETOMIDATE IV SOLN 2 MG/ML,Rx72266014601,CDM,,,250,RC,72266-0146-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx72611073401,CDM,,,250,RC,72611-0734-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",Rx76329331601,CDM,,,250,RC,76329-3316-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",Rx76329331801,CDM,,,250,RC,76329-3318-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),Rx81284061100,CDM,,,250,RC,81284-0611-00,NDC,,BOTH,10,ML,49,44.1,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.02,,,36.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.25,,,24.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML,Rx70121104901,CDM,J3301,HCPCS,636,RC,70121104901,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,2.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHOCARBAMOL INJ 1000 MG/10ML,Rx71288071611,CDM,J2800,HCPCS,636,RC,71288071611,NDC,,BOTH,10,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,8.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MEPERIDINE HCL INJ 25 MG/ML,MEPERIDINE HCL INJ 50 MG/ML,MEPERIDINE HCL INJ 100 MG/ML,MEPERIDINE HCL INJ 75 MG/ML,MEPERIDINE HCL INJ 25 MG/0.5ML (50 MG/ML),MEPERIDINE HCL INJ 100 MG/2ML (50 MG/ML)",Rx00000000339,CDM,J2175,HCPCS,636,RC,339,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML",Rx00000000340,CDM,J2060,HCPCS,636,RC,340,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%",Rx00000003352,CDM,J1170,HCPCS,636,RC,3352,NDC,,BOTH,1,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),Rx00008400101,CDM,C9113,HCPCS,636,RC,8400101,NDC,,BOTH,40,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML,Rx00009030602,CDM,J1040,HCPCS,636,RC,9030602,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG,Rx00009082501,CDM,J1720,HCPCS,636,RC,9082501,NDC,,BOTH,100,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON),Rx00023608201,CDM,J1750,HCPCS,636,RC,23608201,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM,Rx00049001481,CDM,J0295,HCPCS,636,RC,49001481,NDC,,BOTH,1.5,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT,Rx00049042005,CDM,J2540,HCPCS,636,RC,49042005,NDC,,BOTH,5000000,UN,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),Rx00069600102,CDM,Q2009,HCPCS,636,RC,69600102,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETAMINE HCL INJ 100 MG/ML,Rx00143950901,CDM,J3490,HCPCS,636,RC,143950901,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,Rx00143972001,CDM,J1956,HCPCS,636,RC,143972001,NDC,,BOTH,150,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
TERBUTALINE SULFATE INJ 1 MG/ML,Rx00143974601,CDM,J3105,HCPCS,636,RC,143974601,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML),Rx00143978401,CDM,J3490,HCPCS,636,RC,143978401,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROPRANOLOL HCL INJ 1 MG/ML,Rx00143987201,CDM,J1800,HCPCS,636,RC,143987201,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),Rx00143987501,CDM,J0282,HCPCS,636,RC,143987501,NDC,,BOTH,3,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GENTAMICIN IN SALINE INJ 0.8 MG/ML,Rx00338050348,CDM,J1580,HCPCS,636,RC,338050348,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GENTAMICIN IN SALINE INJ 1.6 MG/ML,Rx00338050941,CDM,J1580,HCPCS,636,RC,338050941,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML,Rx00338604537,CDM,J1450,HCPCS,636,RC,338604537,NDC,,BOTH,200,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,Rx00338604648,CDM,J1450,HCPCS,636,RC,338604648,NDC,,BOTH,100,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,Rx00409116218,CDM,J0665,HCPCS,636,RC,409116218,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDROMORPHONE HCL INJ 1 MG/ML,Rx00409128303,CDM,J1170,HCPCS,636,RC,409128303,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML",Rx00409128303,CDM,J1170,HCPCS,636,RC,409128303,NDC,,BOTH,1,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALBUPHINE HCL INJ 10 MG/ML,Rx00409146301,CDM,J2300,HCPCS,636,RC,409146301,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)",Rx00409163015,CDM,J0461,HCPCS,636,RC,409163015,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MORPHINE SULFATE IV SOLN PF 2 MG/ML,Rx00409189003,CDM,J2270,HCPCS,636,RC,409189003,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%",Rx00409189003,CDM,J2270,HCPCS,636,RC,409189003,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)",Rx00409230802,CDM,J2250,HCPCS,636,RC,409230802,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DOBUTAMINE HCL INJ 12.5 MG/ML,Rx00409234401,CDM,J1250,HCPCS,636,RC,409234401,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MORPHINE SULFATE INJ PF 1 MG/ML,Rx00409381511,CDM,J2270,HCPCS,636,RC,409381511,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MANNITOL IV SOLN 25%,Rx00409403101,CDM,J2150,HCPCS,636,RC,409403101,NDC,,BOTH,50,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 250 MG,Rx00409733711,CDM,J0696,HCPCS,636,RC,409733711,NDC,,BOTH,250,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML),Rx00409915731,CDM,J3430,HCPCS,636,RC,409915731,NDC,,BOTH,0.5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHYTONADIONE INJ 10 MG/ML,Rx00409915831,CDM,J3430,HCPCS,636,RC,409915831,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML,Rx00517072001,CDM,J0702,HCPCS,636,RC,517072001,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML",Rx00517100401,CDM,J0461,HCPCS,636,RC,517100401,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DROPERIDOL INJ 2.5 MG/ML,Rx00517970201,CDM,J1790,HCPCS,636,RC,517970201,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIGOXIN INJ 0.25 MG/ML,Rx00641141031,CDM,J1160,HCPCS,636,RC,641141031,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LORAZEPAM INJ 2 MG/ML,Rx00641600101,CDM,J2060,HCPCS,636,RC,641600101,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUMETANIDE INJ 0.25 MG/ML,Rx00641600801,CDM,J1939,HCPCS,636,RC,641600801,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MEPERIDINE HCL INJ 50 MG/ML,Rx00641605301,CDM,J2175,HCPCS,636,RC,641605301,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MORPHINE SULFATE IV SOLN 4 MG/ML,Rx00641612501,CDM,J2270,HCPCS,636,RC,641612501,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML",Rx00641612501,CDM,J2270,HCPCS,636,RC,641612501,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML",Rx00641620901,CDM,J2250,HCPCS,636,RC,641620901,NDC,,BOTH,10,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHENYLEPHRINE HCL IV SOLN 10 MG/ML,Rx00641622901,CDM,J2371,HCPCS,636,RC,641622901,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 500 MG,Rx00781320785,CDM,J0696,HCPCS,636,RC,781320785,NDC,,BOTH,500,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 2 GM,Rx00781320995,CDM,J0696,HCPCS,636,RC,781320995,NDC,,BOTH,2,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OLANZAPINE FOR IM INJ 10 MG,Rx00781910572,CDM,J2359,HCPCS,636,RC,781910572,NDC,,BOTH,10,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMPICILLIN SODIUM FOR INJ 1 GM,Rx00781926185,CDM,J0290,HCPCS,636,RC,781926185,NDC,,BOTH,1,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AMPICILLIN SODIUM FOR INJ 2 GM,Rx00781927380,CDM,J0290,HCPCS,636,RC,781927380,NDC,,BOTH,2,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
POTASSIUM CHLORIDE INJ 10 MEQ/100ML,Rx00990707426,CDM,J3480,HCPCS,636,RC,990707426,NDC,,BOTH,100,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML,Rx08290306424,CDM,J1642,HCPCS,636,RC,8290306424,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFUROXIME SODIUM FOR IV SOLN 1.5 GM,Rx25021011920,CDM,J0697,HCPCS,636,RC,25021011920,NDC,,BOTH,1.5,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,Rx25021018482,CDM,J1450,HCPCS,636,RC,25021018482,NDC,,BOTH,100,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,Rx25021018482,CDM,J1450,HCPCS,636,RC,25021018482,NDC,,BOTH,100,ML,49,44.96,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,Rx25021018482,CDM,J1450,HCPCS,636,RC,25021018482,NDC,,BOTH,100,ML,49,89.91,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML),Rx25021061282,CDM,J3475,HCPCS,636,RC,25021061282,NDC,,BOTH,100,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),Rx25021077702,CDM,J2405,HCPCS,636,RC,25021077702,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OXYTOCIN INJ 10 UNIT/ML,Rx42023011625,CDM,J2590,HCPCS,636,RC,42023011625,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PHYTONADIONE INJ 10 MG/ML,Rx43598040516,CDM,J3430,HCPCS,636,RC,43598040516,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVOFLOXACIN IV SOLN 25 MG/ML,Rx55150015620,CDM,J1956,HCPCS,636,RC,55150015620,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,Rx55150016830,CDM,J0665,HCPCS,636,RC,55150016830,NDC,,BOTH,0.5,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FUROSEMIDE INJ 10 MG/ML,Rx55150032401,CDM,J1940,HCPCS,636,RC,55150032401,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETAMINE HCL INJ 10 MG/ML,Rx55150043801,CDM,J3490,HCPCS,636,RC,55150043801,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFTRIAXONE SODIUM FOR INJ 1 GM,Rx60505614800,CDM,J0696,HCPCS,636,RC,60505614800,NDC,,BOTH,1,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFEPIME HCL FOR INJ 1 GM,Rx60505624500,CDM,J0692,HCPCS,636,RC,60505624500,NDC,,BOTH,1,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GENTAMICIN SULFATE INJ 40 MG/ML,Rx63323001094,CDM,J1580,HCPCS,636,RC,63323001094,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MANNITOL IV SOLN 25%,Rx63323002425,CDM,J2150,HCPCS,636,RC,63323002425,NDC,,BOTH,50,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE INJ 50%,Rx63323006401,CDM,J3475,HCPCS,636,RC,63323006401,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),Rx63323010602,CDM,J3475,HCPCS,636,RC,63323010602,NDC,,BOTH,50,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML),Rx63323010615,CDM,J3475,HCPCS,636,RC,63323010615,NDC,,BOTH,500,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
KETOROLAC TROMETHAMINE INJ 30 MG/ML,Rx63323016243,CDM,J1885,HCPCS,636,RC,63323016243,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GENTAMICIN SULFATE INJ 10 MG/ML,Rx63323017341,CDM,J1580,HCPCS,636,RC,63323017341,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PYRIDOXINE HCL INJ 100 MG/ML,Rx63323018000,CDM,J3415,HCPCS,636,RC,63323018000,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROTAMINE SULFATE INJ 10 MG/ML,Rx63323022995,CDM,J2720,HCPCS,636,RC,63323022995,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROPIVACAINE HCL INJ 5 MG/ML,Rx63323028605,CDM,J2795,HCPCS,636,RC,63323028605,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML),Rx63323037704,CDM,J2354,HCPCS,636,RC,63323037704,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
AZITHROMYCIN IV FOR SOLN 500 MG,Rx63323039814,CDM,J0456,HCPCS,636,RC,63323039814,NDC,,BOTH,500,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),Rx63323040041,CDM,J1953,HCPCS,636,RC,63323040041,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,Rx63323050616,CDM,J1100,HCPCS,636,RC,63323050616,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MEROPENEM IV FOR SOLN 500 MG,Rx63323050720,CDM,J2185,HCPCS,636,RC,63323050720,NDC,,BOTH,500,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
MEROPENEM IV FOR SOLN 1 GM,Rx63323050830,CDM,J2185,HCPCS,636,RC,63323050830,NDC,,BOTH,1,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML),Rx63323057842,CDM,J1596,HCPCS,636,RC,63323057842,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DIPHENHYDRAMINE HCL INJ 50 MG/ML,Rx63323066416,CDM,J1200,HCPCS,636,RC,63323066416,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML,Rx63323080801,CDM,J3010,HCPCS,636,RC,63323080801,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",Rx63323080801,CDM,J3010,HCPCS,636,RC,63323080801,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,Rx63323085303,CDM,J1170,HCPCS,636,RC,63323085303,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),Rx63323098341,CDM,J2543,HCPCS,636,RC,63323098341,NDC,,BOTH,3.375,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
THIAMINE HCL INJ 100 MG/ML,Rx67457019600,CDM,J3411,HCPCS,636,RC,67457019600,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx67457029200,CDM,J2310,HCPCS,636,RC,67457029200,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",Rx67457029200,CDM,J2310,HCPCS,636,RC,67457029200,NDC,,BOTH,10,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NALOXONE HCL INJ 0.4 MG/ML,Rx67457059900,CDM,J2310,HCPCS,636,RC,67457059900,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,Rx67457060202,CDM,J1644,HCPCS,636,RC,67457060202,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)",Rx69918070002,CDM,J0330,HCPCS,636,RC,69918070002,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,Rx69918070002,CDM,J0330,HCPCS,636,RC,69918070002,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML,Rx70121157301,CDM,J1030,HCPCS,636,RC,70121157301,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,Rx71288042096,CDM,J1644,HCPCS,636,RC,71288042096,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%)",Rx76329339001,CDM,J2001,HCPCS,636,RC,76329339001,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV),Rx00009003905,CDM,J2920,HCPCS,636,RC,9003905,NDC,,BOTH,40,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV),Rx00009004722,CDM,J2930,HCPCS,636,RC,9004722,NDC,,BOTH,125,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROMETHAZINE HCL INJ 25 MG/ML,Rx00641092821,CDM,J2550,HCPCS,636,RC,641092821,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
PROMETHAZINE HCL INJ 25 MG/ML,Rx00641620801,CDM,J2550,HCPCS,636,RC,641620801,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CYANOCOBALAMIN INJ 1000 MCG/ML,Rx63323004400,CDM,J3420,HCPCS,636,RC,63323004400,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DOBUTAMINE INJ 2 MG/ML IN D5W,Rx00000000797,CDM,,,250,RC,00000-0007-97,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML,Rx00009090211,CDM,,,250,RC,00009-0902-11,NDC,,BOTH,6,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ENALAPRILAT IV INJ 1.25 MG/ML,Rx00143978601,CDM,,,250,RC,00143-9786-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
METRONIDAZOLE IV SOLN 500 MG/100ML,Rx00338105548,CDM,,,250,RC,00338-1055-48,NDC,,BOTH,100,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CLINDAMYCIN PHOSPHATE IN NACL 0.9% IV SOLN 900 MG/50ML,Rx00338955350,CDM,,,250,RC,00338-9553-50,NDC,,BOTH,50,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",Rx00409177805,CDM,,,250,RC,00409-1778-05,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000,Rx00409318311,CDM,,,250,RC,00409-3183-11,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%,Rx00409361301,CDM,,,250,RC,00409-3613-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,Rx00409428212,CDM,,,250,RC,00409-4282-12,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,Rx00409488803,CDM,,,250,RC,00409-4888-03,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML),Rx00641601301,CDM,,,250,RC,00641-6013-01,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML),Rx00641601501,CDM,,,250,RC,00641-6015-01,NDC,,BOTH,25,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML,Rx16729023930,CDM,,,250,RC,16729-0239-30,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)",Rx43066000710,CDM,,,250,RC,43066-0007-10,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx43066000710,CDM,,,250,RC,43066-0007-10,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BENZYLPENICILLOYL POLYLYSINE INJ 0.25 ML,Rx49471000101,CDM,,,250,RC,49471-0001-01,NDC,,BOTH,0.25,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML",Rx54288012001,CDM,,,250,RC,54288-0120-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ETOMIDATE IV SOLN 2 MG/ML,Rx55150022110,CDM,,,250,RC,55150-0221-10,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)",Rx55150022505,CDM,,,250,RC,55150-0225-05,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),Rx55150022505,CDM,,,250,RC,55150-0225-05,NDC,,BOTH,5,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FOLIC ACID INJ 5 MG/ML,Rx63323018410,CDM,,,250,RC,63323-0184-10,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
WATER FOR INJECTION,Rx63323018510,CDM,,,250,RC,63323-0185-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 1%,Rx63323020110,CDM,,,250,RC,63323-0201-10,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CALCIUM GLUCONATE INJ 10%,Rx63323036001,CDM,,,250,RC,63323-0360-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
CEFOTETAN DISODIUM FOR INJ 1 GM,Rx63323038510,CDM,,,250,RC,63323-0385-10,NDC,,BOTH,1,GR,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML",Rx63323045200,CDM,,,250,RC,63323-0452-00,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF),Rx63323046201,CDM,,,250,RC,63323-0462-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF),Rx63323046801,CDM,,,250,RC,63323-0468-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,Rx63323048205,CDM,,,250,RC,63323-0482-05,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000,Rx63323048303,CDM,,,250,RC,63323-0483-03,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL INJ 2%,Rx63323048641,CDM,,,250,RC,63323-0486-41,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000,Rx63323048707,CDM,,,250,RC,63323-0487-07,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%,Rx63323049157,CDM,,,250,RC,63323-0491-57,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,Rx63323049241,CDM,,,250,RC,63323-0492-41,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VALPROATE SODIUM INJ 100 MG/ML,Rx63323049416,CDM,,,250,RC,63323-0494-16,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FAMOTIDINE INJ 200 MG/20ML,Rx63323073820,CDM,,,250,RC,63323-0738-20,NDC,,BOTH,20,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML,Rx63323073916,CDM,,,250,RC,63323-0739-16,NDC,,BOTH,2,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
VECURONIUM BROMIDE FOR INJ 10 MG,Rx63323078141,CDM,,,250,RC,63323-0781-41,NDC,,BOTH,10,ME,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
EPHEDRINE SULFATE IV SOLN 50 MG/ML,Rx65219025701,CDM,,,250,RC,65219-0257-01,NDC,,BOTH,1,ML,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),Rx67457085200,CDM,,,250,RC,67457-0852-00,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)",Rx72266010201,CDM,,,250,RC,72266-0102-01,NDC,,BOTH,1,EA,49,44.1,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,24.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,44.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000,Rx00362055705,CDM,,,250,RC,00362-0557-05,NDC,,BOTH,1,EA,49,44.1,46.55,,,49.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,43.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,28.135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,28.135,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,49.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,53.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,43.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,43.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,50.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,28.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,46.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,49.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,52.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HISTAMINE PHOSPHATE INJ 2.75 MG/ML (1 MG/ML BASE EQUIV),Rx00268024705,CDM,,,250,RC,00268-0247-05,NDC,,BOTH,1,ML,49,44.1,46.55,,,401.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,347.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,370.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,227.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,370.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,227.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,401.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,427.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.02,,,347.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,347.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,409.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,227.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,378.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,401.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,423.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.01,,,24.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.22,47.04,
HC CAUTERY PENCIL/HOLSTER ROCKER ARM COATED TIP,Sx0000000030H,CDM,,,270,RC,,,,BOTH,,,49.44,41.43,46.97,,,41.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.56,,,35.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.5,,,38.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.5,,,23.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.5,,,38.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.23,,,23.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.5,,,41.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.46,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.34,,,35.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.47,,,35.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.48,,,42.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.23,,,23.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.02,,,39.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.97,,,41.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.5,,,43.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.23,,,24.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.56,47.46,
HC PROMOGRAN PRISMA 4.34X4.34 MA028,Sx000000MA028,CDM,,,270,RC,,,,BOTH,,,49.74,45.54,47.25,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.8,,,38.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,25.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,25.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.75,,,47.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.56,,,38.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,38.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.76,,,45.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,25.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.28,,,42.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.25,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,24.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.8,47.75,
HC MEPILEX BORDER AG DRESSING 4X4,Sx00000395390,CDM,,,270,RC,,,,BOTH,,,49.74,44.77,47.25,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.8,,,38.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,25.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,41.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,25.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.75,,,47.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.56,,,38.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.62,,,38.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.76,,,45.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,25.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.28,,,42.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.25,,,44.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.77,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.37,,,24.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.8,47.75,
HC PR ED VISIT LEVEL I UNRELATED VISIT SAME PHYS,Px00098110488,CDM,99281,CPT,981,RC,,,,OUTPATIENT,,,51,45.9,28.56,,,28.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.75,,,23.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,31.88,,,31.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,31.88,,,31.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,31.88,,,31.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,160.68,,,160.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.8,,,24.8,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.05,,,28.05,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,,,139.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,29.07,,,29.07,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,143.91,,,143.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,27.54,,,27.54,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.56,,,28.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,47.88,,,47.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,47.88,
HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM,Px00098110604,CDM,99281,CPT,981,RC,,,,OUTPATIENT,,,51,45.9,28.56,,,45.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.75,,,39.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.88,,,42.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.88,,,25.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.88,,,42.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.68,,,25.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.8,,,45.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.05,,,48.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,39.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.07,,,46.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,25.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.54,,,43.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.56,,,45.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.88,,,48.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,47.88,
SULFACETAMIDE SODIUM OPHTH SOLN 10%,Rx24208067004,CDM,,,250,RC,24208-0670-04,NDC,,BOTH,1,EA,49.96,38.67,47.46,,,44.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.97,,,38.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.96,,,41.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.96,,,25.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.96,,,41.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.48,,,25.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.96,,,44.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.96,,,47.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.72,,,38.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.73,,,38.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.96,,,45.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.48,,,25.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.47,,,42.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.46,,,44.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.96,,,47.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.48,,,24.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.97,47.96,
HC ASSAY OF AMYLASE #,Px00030100567,CDM,82150,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC ASSAY OF AMYLASE #,Px00030100568,CDM,82150,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC ASSAY OF AMYLASE #,Px00030100569,CDM,82150,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC AMYLASE,Px00030112298,CDM,82150,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC CREATINE KINASE TOTAL #,Px00030100585,CDM,82550,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC CK TOTAL,Px00030014566,CDM,82550,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
HC GAMMA GT TOTAL,Px00030014949,CDM,82977,CPT,300,RC,,,,BOTH,,,50,45,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39,,,39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,25.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,41.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48,,,48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.75,,,39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,25.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.5,,,42.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.5,,,45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45,,,47.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.5,,,24.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39,48,
CALCIUM CHLORIDE INJ 10%,Rx64253090030,CDM,,,250,RC,64253-0900-30,NDC,,BOTH,1,EA,50.08,45.07,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.06,,,39.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.07,,,45.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.07,,,45.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.07,,,45.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.54,,,24.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.07,,,45.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.08,,,48.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.81,,,36.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.78,,,24.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.07,,,46.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.54,,,24.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.57,,,42.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.07,,,45.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.54,,,24.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.06,48.08,
SILVER SULFADIAZINE CREAM 1%,Rx61570013140,CDM,,,250,RC,61570-0131-40,NDC,,BOTH,1,EA,50.29,36.58,47.78,,,47.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.23,,,39.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.26,,,45.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.26,,,45.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.26,,,45.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.64,,,24.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.26,,,45.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.28,,,48.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.96,,,36.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.89,,,24.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.27,,,46.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.64,,,24.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.75,,,42.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.78,,,47.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.26,,,45.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.64,,,24.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.23,48.28,
HC CVPRESSURE TRANSDUCER IV,Px00007160WNH,CDM,,,270,RC,,,,BOTH,,,50.34,45.31,47.82,,,45.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.27,,,39.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.31,,,41.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.31,,,25.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.31,,,41.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.67,,,25.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.31,,,45.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.33,,,48.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37,,,39.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.91,,,39.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.67,,,25.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.79,,,42.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.82,,,45.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.31,,,47.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.67,,,24.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.27,48.33,
HC NEEDLE ILLINOIS BONE MARROW,Sx000DIN1515X,CDM,,,270,RC,,,,BOTH,,,50.44,45.4,47.92,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.34,,,39.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,25.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.72,,,25.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.42,,,48.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.07,,,39.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.96,,,39.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.4,,,46.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.72,,,25.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.87,,,42.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.92,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,47.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.72,,,24.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.34,48.42,
MORPHINE SULFATE INJ PF 1 MG/ML,Rx00409381512,CDM,J2270,HCPCS,636,RC,409381512,NDC,,BOTH,1,ML,50.55,45.5,48.02,,,48.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.43,,,39.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.5,,,45.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.5,,,45.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.5,,,45.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.77,,,24.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.5,,,45.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.53,,,48.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.15,,,37.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,24.77,,,24.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.51,,,46.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.77,,,24.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.97,,,42.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.02,,,48.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.5,,,45.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,24.77,,,24.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.43,48.53,
HC ARTERIAL RADIAL CATHETER SET,Px00007479WNH,CDM,,,270,RC,,,,BOTH,,,50.76,45.68,48.22,,,45.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,39.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.68,,,42.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.68,,,25.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.68,,,42.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.87,,,25.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.68,,,45.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.73,,,48.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.31,,,39.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.12,,,39.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,46.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.87,,,25.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,43.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,45.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.68,,,48.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.87,,,24.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.59,48.73,
HC CATH FOLEY 3 WAY 16FR 34CM CLOSED END ROUND TIP,Sx08887664161,CDM,,,270,RC,,,,BOTH,,,50.96,40.18,48.41,,,40.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.75,,,34.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,37.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,22.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,37.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.97,,,22.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,40.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.92,,,42.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.46,,,34.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.22,,,34.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.88,,,41.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.97,,,22.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.32,,,37.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.41,,,40.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,42.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.97,,,24.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.75,48.92,
HC DRUG TEST PRSMV CHEM ANLYZR ACETAMINOPHEN PER DOS,Px00030114382,CDM,80307,CPT,300,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS,Px00030114383,CDM,80307,CPT,300,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC DRUG TEST PRSMV CHEM ANLYZR CORDSTAT PER DOS,Px00030114389,CDM,80307,CPT,300,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS #,Px00030114403,CDM,80307,CPT,300,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE #,Px00030100553,CDM,80307,CPT,300,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC OPERATING ROOM SERVICES LEVEL 1 PER MIN,Px00036010212,CDM,,,360,RC,,,,BOTH,,,51,45.9,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,39.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,25.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,42.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.96,,,48.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,39.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.92,,,46.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,25.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.35,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24.99,,,24.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.78,48.96,
HC COLLAR PERFIT MINI PED INFANT/NONECK,Sx00000281106,CDM,L0120,HCPCS,274,RC,,,,BOTH,,,51.06,37.75,48.51,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.83,,,32.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.95,,,34.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.95,,,21.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.95,,,34.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.02,,,21.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.95,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,40.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.53,,,32.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.27,,,32.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.98,,,38.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.02,,,21.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.4,,,35.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,37.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.95,,,39.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.02,,,25.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.83,49.02,
WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT,Rx10119002239,CDM,,,250,RC,10119-0022-39,NDC,,BOTH,1,EA,51.52,46.37,48.94,,,46.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.19,,,40.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,42.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,26.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,42.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,26.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,46.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,49.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.87,,,40.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.5,,,40.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.4,,,47.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,26.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.79,,,43.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.94,,,46.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.37,,,48.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.24,,,25.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.19,49.46,
HC MAGNESIUM,Px00030112248,CDM,83735,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISCELLANEOUS BODY FLUIDS #,Px00030000003,CDM,89050,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISCELLANEOUS BODY FLUIDS #,Px00030000007,CDM,89050,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,Px00030000004,CDM,89051,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,Px00030000008,CDM,89051,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,Px00030000010,CDM,89051,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,Px00030000011,CDM,89051,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC BODY FLUID CELL COUNT W/ DIFFERENTIAL,Px00030011520,CDM,89051,CPT,300,RC,,,,BOTH,,,52,46.8,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.56,,,40.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,26.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,43.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.73,,,40.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.84,,,47.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,26.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.2,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.4,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,49.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.48,,,25.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.56,49.92,
HC TED HOSE THIGH HIGH LENGTH LG,Px00012778WNH,CDM,,,270,RC,,,,BOTH,,,52.08,46.87,49.48,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.62,,,40.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,26.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,26.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,46.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50,,,50,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,40.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.77,,,40.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.91,,,47.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,26.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.27,,,44.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.48,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,49.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,25.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.62,50,
HC DRESSING MEPILEX AG 4X5 ANTIMICRO,Sx00000287090,CDM,,,270,RC,,,,BOTH,,,52.08,46.87,49.48,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.62,,,40.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,26.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,43.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,26.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,46.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50,,,50,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,40.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.77,,,40.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.91,,,47.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,26.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.27,,,44.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.48,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.87,,,49.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.52,,,25.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.62,50,
SULFACETAMIDE SODIUM OPHTH SOLN 10%,Rx61314070101,CDM,,,250,RC,61314-0701-01,NDC,,BOTH,1,EA,52.21,46.99,49.6,,,49.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,40.72,,,40.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.99,,,46.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.99,,,46.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.99,,,46.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.58,,,25.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.99,,,46.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,50.12,,,50.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.37,,,38.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.84,,,25.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.03,,,48.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.58,,,25.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.38,,,44.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.6,,,49.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.99,,,46.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,25.58,,,25.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.72,50.12,
SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML,Rx00143963801,CDM,J3030,HCPCS,636,RC,143963801,NDC,,BOTH,0.5,ML,52.55,47.3,49.92,,,47.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.99,,,41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,43.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,43.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.75,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,47.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.45,,,52.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.62,,,41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.75,,,41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.35,,,48.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.75,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.67,,,44.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,47.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,49.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.75,,,25.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,40.99,50.45,
HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE,Px00030015078,CDM,83050,CPT,300,RC,,,,BOTH,,,53,47.7,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,41.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,27.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.88,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.23,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.76,,,48.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,50.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.34,50.88,
HC IRON,Px00030015298,CDM,83540,CPT,300,RC,,,,BOTH,,,53,47.7,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,41.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,27.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.88,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.23,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.76,,,48.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,50.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.34,50.88,
HC ASSAY OF LIPASE #,Px00030100626,CDM,83690,CPT,300,RC,,,,BOTH,,,53,47.7,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,41.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,27.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.88,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.23,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.76,,,48.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,50.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.34,50.88,
HC LIPASE,Px00030013912,CDM,83690,CPT,300,RC,,,,BOTH,,,53,47.7,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,41.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,27.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.88,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.23,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.76,,,48.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,50.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.34,50.88,
HC ELEC STIM UNATTENDED TO 1 OR MORE AREAS OTHER THAN WOUND CARE,Px00042010270,CDM,G0283,CPT,420,RC,,,,BOTH,,,53,47.7,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,41.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,27.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,44.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.88,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.96,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.23,,,41.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.76,,,48.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,27.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.35,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.7,,,50.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.34,50.88,
HC CULTR BACTERIA EXCEPT BLOOD,Px00030011159,CDM,87075,CPT,300,RC,,,,BOTH,,,53.41,48.07,50.74,,,48.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.07,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.07,,,27.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.07,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.17,,,27.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.07,,,48.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,51.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.26,,,41.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.43,,,41.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.14,,,49.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.17,,,27.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.4,,,45.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.74,,,48.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.07,,,50.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.17,,,26.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.66,51.27,
HC K-WIRE 80MM,Sx000451-1136,CDM,,,270,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC PORTAL SKID,Sx0000AR-4505,CDM,,,270,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC ELECTROLYTE PANEL,Px00030112031,CDM,80051,CPT,300,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC ASSAY OF THYROXINE TOTAL #,Px00030100658,CDM,84436,CPT,300,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC THYROXINE T4,Px00030016044,CDM,84436,CPT,300,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC FETAL/MATERNAL BLOOD SCREEN,Px00030014884,CDM,85460,CPT,300,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC RUSSELL VIPER VENOM TIME DILUTED #,Px00030510327,CDM,85613,CPT,300,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC XR SURGICAL SPECIMEN,Px00032010322,CDM,76098,CPT,320,RC,,,,BOTH,,,54,48.6,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.12,,,42.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,27.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,44.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,51.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.69,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,42.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.68,,,49.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,27.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.9,,,45.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,48.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.6,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.46,,,26.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.12,51.84,
HC OSTOMY POWDER STOMA 0,Sx00000025510,CDM,,,270,RC,,,,BOTH,,,54.12,4.5,51.41,,,48.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.21,,,42.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.71,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.71,,,27.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.71,,,45.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,27.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.71,,,48.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,51.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.78,,,42.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.78,,,42.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.79,,,49.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,27.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.41,,,48.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.71,,,51.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.52,,,26.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.21,51.96,
TUBERCULIN PPD INJ 5 UNIT/0.1ML,Rx42023010401,CDM,,,250,RC,42023-0104-01,NDC,,BOTH,0.1,ML,54.23,45.23,51.52,,,48.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.3,,,42.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.81,,,45.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.81,,,27.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.81,,,45.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.57,,,27.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.81,,,48.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.06,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.86,,,42.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.84,,,42.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.89,,,49.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.57,,,27.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.1,,,46.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.52,,,48.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.81,,,51.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.57,,,26.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.3,52.06,
HC PR 11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM  CDM,Px00097513998,CDM,11045,CPT,975,RC,,,,BOTH,,,97,87.3,54.32,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.49,,,75.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,126.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,126.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.39,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.32,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.35,,,37.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.82,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.82,,,75.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.29,,,89.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.53,,,49.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.29,,,82.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.32,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,92.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.82,,,23.82,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.82,52.2,
HC ASSAY OF PHOSPHATASE ACID PROSTATIC #,Px00030112081,CDM,84066,CPT,300,RC,,,,BOTH,,,54.48,49.03,51.76,,,49.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.49,,,42.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.03,,,45.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.03,,,27.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.03,,,45.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.7,,,27.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.03,,,49.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.3,,,52.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.04,,,42.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.96,,,42.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.12,,,50.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.7,,,27.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.76,,,49.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.03,,,51.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.7,,,26.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.49,52.3,
HC HEPATIC FUNCTION PANEL,Px00030112103,CDM,80076,CPT,300,RC,,,,BOTH,,,54.54,49.09,51.81,,,56.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.54,,,49.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.09,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.09,,,32.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.09,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,32.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.09,,,56.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.36,,,60.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.09,,,49.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,26.99,,,49.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.18,,,57.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,32.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.36,,,53.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.81,,,56.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.09,,,59.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.72,,,26.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.54,52.36,
BARICITINIB TAB 2 MG,Rx00002418230,CDM,,,250,RC,00002-4182-30,NDC,,BOTH,2,ME,54.61,47.15,51.88,,,49.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.6,,,42.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.15,,,45.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.15,,,27.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.15,,,45.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.15,,,49.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.14,,,42.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,42.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.24,,,50.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.42,,,46.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.88,,,49.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.15,,,51.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,26.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.6,52.43,
HC AIRWAY LMA UNIQUE NO 5 SINGLE USE DISP,Sx105300-0000,CDM,,,270,RC,,,,BOTH,,,54.62,49.16,51.89,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.6,,,42.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,45.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,27.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,45.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.15,,,42.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,42.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.25,,,50.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.43,,,46.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.89,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,51.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,26.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.6,52.44,
HC AIRWAY LMA UNIQUE NO 3 SINGLE USE DISP,Sx105300-0000,CDM,,,270,RC,,,,BOTH,,,54.62,49.16,51.89,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.6,,,42.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,45.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,27.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,45.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.15,,,42.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.03,,,42.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.25,,,50.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,27.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.43,,,46.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.89,,,49.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.16,,,51.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.76,,,26.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.6,52.44,
HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE #,Px00030100467,CDM,82955,CPT,300,RC,,,,BOTH,,,54.7,49.23,51.97,,,49.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.67,,,42.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,27.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,49.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.51,,,52.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.2,,,42.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.07,,,42.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.32,,,50.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,27.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.5,,,46.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.97,,,49.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,51.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,26.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.67,52.51,
HC ASSAY OF G6PD ENZYME,Px00030112250,CDM,82955,CPT,300,RC,,,,BOTH,,,54.7,49.23,51.97,,,49.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.67,,,42.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,27.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,45.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,27.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,49.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.51,,,52.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.2,,,42.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.07,,,42.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.32,,,50.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,27.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.5,,,46.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.97,,,49.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.23,,,51.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.8,,,26.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.67,52.51,
HC ASSAY OF ALDOLASE,Px00030013019,CDM,82085,CPT,300,RC,,,,BOTH,,,54.76,49.28,52.02,,,49.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.71,,,42.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.28,,,45.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.28,,,27.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.28,,,45.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,27.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.28,,,49.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.57,,,52.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.25,,,42.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.1,,,42.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.38,,,50.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,27.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,46.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.02,,,49.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.28,,,52.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.83,,,26.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.71,52.57,
HC FIBRINOGEN,Px00030510063,CDM,85384,CPT,300,RC,,,,BOTH,,,54.82,49.34,52.08,,,49.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.76,,,42.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,45.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,27.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,45.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.86,,,27.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,49.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.63,,,52.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.29,,,42.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.13,,,42.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.43,,,50.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.86,,,27.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.6,,,46.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.08,,,49.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.86,,,26.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.76,52.63,
HC PR ED 29130 APLICATION OF FINGER SPLINT STATIC CDM,Px00098110906,CDM,29130,CPT,981,RC,,,,OUTPATIENT,,,97,87.3,54.32,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.05,,,75.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,126.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,126.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.31,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.35,,,38.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.12,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.12,,,75.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.29,,,89.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,49.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.29,,,82.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.32,,,87.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.65,,,92.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.12,,,28.12,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.12,52.65,
IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON),Rx00023608210,CDM,J1750,HCPCS,636,RC,23608210,NDC,,BOTH,1,ML,54.89,47.09,52.15,,,52.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.81,,,42.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.4,,,49.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.4,,,49.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.4,,,49.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,26.9,,,26.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.4,,,49.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.69,,,52.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,40.34,,,40.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,26.9,,,26.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.5,,,50.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,26.9,,,26.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.66,,,46.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.15,,,52.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.4,,,49.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,26.9,,,26.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.81,52.69,
HC DVT SLEEVE STANDARD,Px00007493WNH,CDM,,,270,RC,,,,BOTH,,,54.96,49.46,52.21,,,49.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.87,,,42.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,45.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,28.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,45.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.93,,,28.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,49.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,52.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.4,,,42.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.2,,,42.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.56,,,50.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.93,,,28.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.72,,,46.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.21,,,49.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.46,,,52.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.93,,,26.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.87,52.76,
NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%,Rx24208063562,CDM,,,250,RC,24208-0635-62,NDC,,BOTH,1,ML,54.99,48.14,52.24,,,49.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.89,,,42.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,45.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,45.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.79,,,52.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,42.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.21,,,42.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.59,,,50.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,46.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.24,,,49.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,52.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.89,52.79,
HC HPYLORI DRUG ADMINISTRATION #,Px00030100618,CDM,83014,CPT,300,RC,,,,BOTH,,,55,49.5,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.9,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.8,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.43,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.22,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.6,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.9,52.8,
HC H PYLORI DRUG ADMIN/COLLECT,Px00030015033,CDM,83014,CPT,300,RC,,,,BOTH,,,55,49.5,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.9,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.8,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.43,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.22,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.6,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.9,52.8,
HC PORPHOBILINOGEN QUANT URINE,Px00030015719,CDM,84110,CPT,300,RC,,,,BOTH,,,55,49.5,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.9,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.8,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.43,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.22,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.6,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.9,52.8,
HC ELECTRIC STIMULATION THERAPY,Px00042010113,CDM,97014,CPT,420,RC,,,,BOTH,,,55,49.5,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.9,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.8,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.43,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.22,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.6,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.9,52.8,
"HC ULTRASOUND THERAPY, EA 15 MIN",Px00042010127,CDM,97035,CPT,420,RC,,,,BOTH,,,55,49.5,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.9,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.8,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.43,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.22,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.6,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,26.95,,,26.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.9,52.8,
HC DVT SLEEVE X-LG,Px00007494WNH,CDM,,,270,RC,,,,BOTH,,,55.26,49.73,52.5,,,49.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.1,,,43.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.73,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.73,,,28.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.73,,,46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,28.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.73,,,49.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.05,,,53.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.62,,,43.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.35,,,43.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.84,,,50.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,28.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.97,,,46.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.5,,,49.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.73,,,52.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.08,,,27.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.1,53.05,
POTASSIUM CHLORIDE INJ 10 MEQ/100ML,Rx14789010916,CDM,J3480,HCPCS,636,RC,14789010916,NDC,,BOTH,100,ML,55.35,49.82,52.58,,,52.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.17,,,43.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.82,,,49.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.82,,,49.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.82,,,49.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.12,,,27.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.82,,,49.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.14,,,53.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,40.68,,,40.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,27.12,,,27.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.92,,,50.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.12,,,27.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.05,,,47.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.58,,,52.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.82,,,49.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.12,,,27.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.17,53.14,
NAFCILLIN SODIUM FOR INJ 2 GM,Rx63323032822,CDM,,,250,RC,63323-0328-22,NDC,,BOTH,2,GR,55.41,49.87,52.64,,,49.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.22,,,43.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.87,,,46.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.87,,,28.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.87,,,46.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.15,,,28.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.87,,,49.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.19,,,53.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.73,,,43.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.42,,,43.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.98,,,50.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.15,,,28.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.1,,,47.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.64,,,49.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.87,,,52.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.15,,,27.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.22,53.19,
DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%,Rx24208072002,CDM,,,250,RC,24208-0720-02,NDC,,BOTH,1,EA,55.47,44.69,52.7,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.27,,,43.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,46.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,28.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,46.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.18,,,28.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.25,,,53.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.77,,,43.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.45,,,43.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.03,,,51.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.18,,,28.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.15,,,47.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.7,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,52.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.18,,,27.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.27,53.25,
CEFTAZIDIME FOR IV SOLN 2 GM,Rx25021012850,CDM,J0713,HCPCS,636,RC,25021012850,NDC,,BOTH,2,GR,55.68,50.15,52.9,,,50.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.43,,,43.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,28.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.28,,,28.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,50.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.45,,,53.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.92,,,43.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.28,,,43.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.23,,,51.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.28,,,28.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.33,,,47.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.9,,,50.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,52.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.28,,,27.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.43,53.45,
"HC ELECTRICAL STIMULATION ATTENDED, EA 15 MIN",Px00042010124,CDM,97032,CPT,420,RC,,,,BOTH,,,56,50.4,53.2,,,50.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.68,,,43.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,46.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,28.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,46.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.44,,,28.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,50.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,53.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,43.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.71,,,43.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.52,,,51.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.44,,,28.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.6,,,47.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,50.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,53.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.44,,,27.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.68,53.76,
HC EYE GARD STRL LTX FR DUPACO,Sx00000028310,CDM,,,270,RC,,,,BOTH,,,56.25,43.42,53.44,,,50.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.88,,,43.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,46.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,28.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,46.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.56,,,28.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,50.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.34,,,43.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.84,,,43.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.75,,,51.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.56,,,28.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.81,,,47.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.44,,,50.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,53.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.56,,,27.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.88,54,
HC PR 99418 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN CDM,Px00098300452,CDM,99418,CPT,987,RC,,,,BOTH,,,93,83.7,52.08,,,83.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.15,,,72.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.13,,,77.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.13,,,47.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.13,,,77.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.66,,,47.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,83.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.15,,,89.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.05,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24.05,,,72.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.01,,,85.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,47.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.01,,,79.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.08,,,83.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.13,,,88.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.05,,,24.05,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,24.05,54.13,
HC TED HOSE THIGH LENGTH XL REG,Px00012779WNH,CDM,,,270,RC,,,,BOTH,,,56.76,51.08,53.92,,,51.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.27,,,44.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,28.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,28.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,51.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.49,,,54.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.72,,,44.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.09,,,44.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.22,,,52.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,28.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,48.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.92,,,51.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,53.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,27.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.27,54.49,
HC TED HOSE THIGH LENGTH XXL REG,Px00012780WNH,CDM,,,270,RC,,,,BOTH,,,56.76,51.08,53.92,,,51.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.27,,,44.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,28.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,47.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,28.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,51.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.49,,,54.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.72,,,44.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.09,,,44.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.22,,,52.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,28.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,48.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.92,,,51.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.08,,,53.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.81,,,27.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.27,54.49,
METHYLERGONOVINE MALEATE TAB 0.2 MG,Rx60687041011,CDM,,,250,RC,60687-0410-11,NDC,,BOTH,0.2,ME,56.77,51.09,53.93,,,53.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.28,,,44.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.09,,,51.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.09,,,51.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.09,,,51.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.82,,,27.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.09,,,51.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.5,,,54.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.73,,,41.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.1,,,28.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.23,,,52.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.82,,,27.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.25,,,48.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.93,,,53.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.09,,,51.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,27.82,,,27.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.28,54.5,
HC MEDIHONEY HYDROGEL 4.3X4.3 NON ADHESIVE DRESSING,Sx00000031640,CDM,,,270,RC,,,,BOTH,,,56.93,51.71,54.08,,,51.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.41,,,44.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,29.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,51.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,54.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.84,,,44.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.17,,,44.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.38,,,52.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,29.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.39,,,48.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.08,,,51.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,54.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.9,,,27.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.41,54.65,
PAMIDRONATE DISODIUM IV SOLN 3 MG/ML,Rx67457043010,CDM,J2430,HCPCS,636,RC,67457043010,NDC,,BOTH,1,ML,56.97,51.33,54.12,,,51.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.44,,,44.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,47.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,29.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,47.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,29.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,51.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.69,,,54.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.87,,,44.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,44.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.41,,,52.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,29.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.42,,,48.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.12,,,51.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.27,,,54.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.92,,,27.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.44,54.69,
HC COMPRESSION SLEEVE CALF MEDIUM,Px00013904WNH,CDM,,,270,RC,,,,BOTH,,,57,51.3,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC HCG SCREEN (SERUM),Px00030015043,CDM,84703,CPT,300,RC,,,,BOTH,,,57,51.3,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC #,Px00030500141,CDM,85025,CPT,300,RC,,,,BOTH,,,57,51.3,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC #,Px00030500142,CDM,85025,CPT,300,RC,,,,BOTH,,,57,51.3,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC BLOOD TYPING SEROLOGIC ABO #,Px00030210907,CDM,86900,CPT,300,RC,,,,BOTH,,,57,22.5,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC RH TYPE,Px00030211142,CDM,86901,CPT,300,RC,,,,BOTH,,,57,22.5,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC BILL SURG LEVEL 2,Px00031010233,CDM,88302,CPT,300,RC,,,,BOTH,,,57,51.3,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.46,,,44.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,29.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,47.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,54.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.9,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,44.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,29.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,51.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,54.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,27.93,,,27.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.46,54.72,
HC PR 76942 ECHO GUIDE FOR BIOPSY,Px00098310832,CDM,76942,CPT,983,RC,,,,BOTH,,,71,63.9,39.76,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,55.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,58.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,58.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.73,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.18,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.05,,,68.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.73,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.73,,,55.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.47,,,65.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.21,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.47,,,60.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.76,,,63.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.38,,,67.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.73,,,121.73,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,121.73,55.38,
BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000,Rx63323046101,CDM,,,250,RC,63323-0461-01,NDC,,BOTH,1,EA,57.71,51.94,54.82,,,51.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.01,,,45.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,48.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,29.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,48.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.28,,,29.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.4,,,55.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.42,,,45.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.56,,,45.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.09,,,53.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.28,,,29.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.05,,,49.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.82,,,51.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.28,,,28.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.01,55.4,
HC CATH RADIAL ARTERY 20G SET 22G INTEGRAL GUIDE,Sx000RA-04020,CDM,,,270,RC,,,,BOTH,,,57.77,51.99,54.88,,,52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.06,,,45.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.99,,,48.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.99,,,29.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.99,,,48.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.31,,,29.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.99,,,52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.46,,,55.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.46,,,45.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.59,,,45.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.15,,,53.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.31,,,29.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.1,,,49.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.99,,,54.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.31,,,28.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.06,55.46,
HC ACETONES KETONES SERUM QUANT,Px00030014072,CDM,82010,CPT,300,RC,,,,BOTH,,,58,52.2,55.1,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.24,,,45.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,48.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,29.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,48.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,29.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.68,,,55.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.7,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.36,,,53.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,29.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.3,,,49.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,55.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,28.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.24,55.68,
HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL,Px00042010110,CDM,97012,CPT,420,RC,,,,BOTH,,,58,52.2,55.1,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.24,,,45.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,48.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,29.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,48.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,29.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.68,,,55.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.7,,,45.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.36,,,53.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,29.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.3,,,49.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,52.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,55.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.42,,,28.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.24,55.68,
TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML,Rx00409656202,CDM,J1071,HCPCS,636,RC,409656202,NDC,,BOTH,1,ML,58.15,52.34,55.24,,,52.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.36,,,45.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.34,,,99.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.34,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.34,,,99.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.49,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.34,,,52.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.82,,,3.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.74,,,45.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.49,,,45.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.49,,,29.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.43,,,49.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.24,,,52.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.34,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.49,,,28.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.36,55.82,
HC PR 01992 ANESTH N BLOCK/INJ PRONE,Px00096310204,CDM,1992,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01360 ANESTH KNEE AREA SURGERY,Px00096310129,CDM,1360,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00902 ANESTH ANORECTAL SURGERY,Px00096310089,CDM,902,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01630 ANESTH SURGERY OF SHOULDER OPEN OR SURGICAL ARTHRO,Px00096310159,CDM,1630,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01472 ANESTH ACHILLES TENDON SURG,Px00096310145,CDM,1472,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00402 ANESTH SURGERY OF BREAST,Px00096310029,CDM,402,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00950 ANESTH VAGINAL ENDOSCOPY,Px00096310108,CDM,950,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01969 ANESTH/ANALG CS HYST ADD-ON,Px00096310201,CDM,1969,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00813 ANES UPPR LWR GI NDSC PX,Px00096310286,CDM,813,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01610 ANESTH SURGERY OF SHOULDER AND AXILLA,Px00096310156,CDM,1610,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00916 ANESTH BLEEDING CONTROL,Px00096310096,CDM,916,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01112 ANESTH BONE ASPIRATE/BX,Px00096310110,CDM,1112,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00731 ANES UPPR GI NDSC PX NOS,Px00096310282,CDM,731,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,48.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01967 ANESTH/ANALG VAG DELIVERY,Px00096310199,CDM,1967,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00450 ANESTH SURGERY OF SHOULDER,Px00096310033,CDM,450,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01474 ANESTH LOWER LEG SURGERY,Px00096310146,CDM,1474,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,87.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,91.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 00834 ANESTH HERNIA REPAIR < 1 YR,Px00096310074,CDM,834,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,64.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01958 ANESTH ANTEPARTUM MANIPUL,Px00096310193,CDM,1958,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,64.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC PR 01960 ANESTH VAGINAL DELIVERY,Px00096310194,CDM,1960,CPT,963,RC,,,,BOTH,,,86,77.4,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.58,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.75,,,76.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.3,,,88.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,71.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,71.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,84.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,77.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.16,,,82.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,64.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.42,55.9,BASE FEE
HC FOAM VAC SMALL WHITE,Px00009307WNH,CDM,,,270,RC,,,,BOTH,,,58.62,52.76,55.69,,,52.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.72,,,45.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,48.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,29.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,48.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.72,,,29.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,52.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.28,,,56.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.09,,,45.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.01,,,45.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.93,,,53.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.72,,,29.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.83,,,49.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.69,,,52.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.76,,,55.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.72,,,28.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.72,56.28,
CALCIUM CHLORIDE INJ 10%,Rx76329330401,CDM,,,250,RC,76329-3304-01,NDC,,BOTH,1,EA,58.79,53.03,55.85,,,55.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.86,,,45.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.81,,,28.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.44,,,56.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.21,,,43.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.1,,,29.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.09,,,54.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.81,,,28.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.97,,,49.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.85,,,55.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.81,,,28.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.86,56.44,
PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML,Rx23155052341,CDM,J0780,HCPCS,636,RC,23155052341,NDC,,BOTH,2,ML,59.11,53.2,56.15,,,56.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.11,,,46.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.2,,,53.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.2,,,53.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.2,,,53.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.96,,,28.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.2,,,53.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.75,,,56.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.45,,,43.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,28.96,,,28.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.38,,,54.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.96,,,28.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.24,,,50.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.15,,,56.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.2,,,53.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,28.96,,,28.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.11,56.75,
PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML,Rx23155052331,CDM,J0780,HCPCS,636,RC,23155052331,NDC,,BOTH,2,ML,59.11,53.2,56.15,,,53.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.11,,,46.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,49.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,30.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,49.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,30.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,53.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.75,,,56.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.45,,,46.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,46.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.38,,,54.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,30.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.24,,,50.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.15,,,53.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,28.96,,,28.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.11,56.75,
NEOMYCIN-POLYMY-GRAMICID OP SOL 1.75-10000-0.025MG-UNT-MG/ML,Rx24208079062,CDM,,,250,RC,24208-0790-62,NDC,,BOTH,1,ML,59.41,49.52,56.44,,,53.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.34,,,46.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.47,,,49.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.47,,,30.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.47,,,49.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,30.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.47,,,53.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.03,,,57.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.67,,,46.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,46.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.66,,,54.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,30.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.5,,,50.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.44,,,53.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.47,,,56.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.11,,,29.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.34,57.03,
CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML,Rx00781329009,CDM,,,250,RC,00781-3290-09,NDC,,BOTH,50,ML,59.73,57.71,56.74,,,53.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.59,,,46.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,49.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,30.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,49.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,30.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,53.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.34,,,57.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.9,,,46.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.56,,,46.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.95,,,54.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,30.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.77,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.74,,,53.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.76,,,56.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.27,,,29.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.59,57.34,
ATROPINE SULFATE OPHTH SOLN 1%,Rx17478021505,CDM,,,250,RC,17478-0215-05,NDC,,BOTH,1,EA,59.8,53.82,56.81,,,56.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,46.64,,,46.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.3,,,29.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.41,,,57.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.95,,,43.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.6,,,29.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.02,,,55.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.3,,,29.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.83,,,50.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.81,,,56.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.3,,,29.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.64,57.41,
HC QUIKCLOT CLOTTING GAUZE 3X24,Px00011019WNH,CDM,,,270,RC,,,,BOTH,,,59.94,53.95,56.94,,,53.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.75,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.95,,,49.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.95,,,30.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.95,,,49.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.37,,,30.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.95,,,53.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.54,,,57.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.06,,,46.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.66,,,46.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.14,,,55.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.37,,,30.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.95,,,50.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,53.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.95,,,56.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.37,,,29.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.75,57.54,
HC MYOSURE SINGLE USE SEAL SET,Sx0000040-902,CDM,,,270,RC,,,,BOTH,,,60,54,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.69,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.2,,,55.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51,,,51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,29.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.8,57.6,
HC FLUENT PACKAGED TISSUE SOCK DISPOSABLE,Sx0000FLT-010,CDM,,,270,RC,,,,BOTH,,,60,54,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.69,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.2,,,55.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51,,,51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,29.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.8,57.6,
HC TUBING FLUID WARMER RANGER STD W/EXT,Sx00000024250,CDM,,,270,RC,,,,BOTH,,,60,54.62,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.8,,,46.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,30.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.69,,,46.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.2,,,55.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51,,,51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54,,,57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,29.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.8,57.6,
CEFAZOLIN SODIUM FOR IV SOLN 1 GM AND DEXTROSE 4% (50 ML),Rx00264310311,CDM,J0690,HCPCS,636,RC,264310311,NDC,,BOTH,50,ML,60.01,48.26,57.01,,,54.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.81,,,46.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.01,,,49.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.01,,,30.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.01,,,49.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.01,,,54.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.61,,,57.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.11,,,46.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,46.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.21,,,55.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,30.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.01,,,51.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.01,,,54.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.01,,,57.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.4,,,29.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,46.81,57.61,
HC DISSECTOR BLUNT TIP PEANUT 5MM 5MM DIAMETER,Sx000000BTD05,CDM,,,270,RC,,,,BOTH,,,60.44,59.73,57.42,,,59.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.14,,,51.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,55.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,33.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,55.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.62,,,33.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,59.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,63.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.42,,,51.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.91,,,51.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.6,,,61.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.62,,,33.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.37,,,56.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.42,,,59.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,63.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.62,,,29.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.14,58.02,
HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM #,Px00030100455,CDM,84165,CPT,300,RC,,,,BOTH,,,60.57,54.51,57.54,,,54.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.24,,,47.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.51,,,50.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.51,,,30.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.51,,,50.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.68,,,30.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.51,,,54.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.15,,,58.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.52,,,47.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,29.98,,,47.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.72,,,55.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.68,,,30.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.54,,,54.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.51,,,57.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.68,,,29.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.24,58.15,
HC BANDAGE MULTI-LAYER,Sx0000MSC4400,CDM,,,270,RC,,,,BOTH,,,60.71,54.64,57.67,,,54.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.35,,,47.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.64,,,50.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.64,,,30.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.64,,,50.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.64,,,54.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.28,,,58.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.62,,,47.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.05,,,47.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.85,,,55.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.6,,,51.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.67,,,54.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.64,,,57.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,29.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.35,58.28,
HC CONTACT LAYER >16 <= 48 SQ IN,Px00005959WNH,CDM,,,270,RC,,,,BOTH,,,60.72,54.65,57.68,,,54.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.36,,,47.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,50.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,30.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,50.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,54.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,58.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.63,,,47.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.05,,,47.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,55.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,30.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.61,,,51.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.68,,,54.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.65,,,57.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.75,,,29.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.36,58.29,
OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML,Rx70092106807,CDM,,,250,RC,70092-1068-07,NDC,,BOTH,1,EA,60.75,54.68,57.71,,,54.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.39,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,50.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,30.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,50.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,30.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,54.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.32,,,58.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.65,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.07,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.89,,,55.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,30.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.64,,,51.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.71,,,54.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,57.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.77,,,29.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.39,58.32,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML,Rx00955101010,CDM,J1650,HCPCS,636,RC,955101010,NDC,,BOTH,1,ML,60.81,54.73,57.77,,,57.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.43,,,47.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.73,,,54.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.73,,,54.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.73,,,54.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.8,,,29.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.73,,,54.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.38,,,58.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.7,,,44.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.8,,,29.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.95,,,55.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.8,,,29.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.69,,,51.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.77,,,57.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.73,,,54.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.8,,,29.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.43,58.38,
DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML),Rx70860030143,CDM,J7999,HCPCS,636,RC,70860030143,NDC,,BOTH,125,ML,60.91,54.82,57.86,,,57.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.51,,,47.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.85,,,29.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.47,,,58.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,44.77,,,44.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,29.85,,,29.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.04,,,56.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.85,,,29.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.77,,,51.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.86,,,57.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,29.85,,,29.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.51,58.47,
HC IRON BINDING CAPACITY,Px00030015300,CDM,83550,CPT,300,RC,,,,BOTH,,,61,54.9,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,31.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.56,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.84,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.19,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,56.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.85,,,51.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,57.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,29.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,58.56,
HC CULTURE AEROBIC IDENTIFY - BACTERIAL ID,Px00030610362,CDM,87077,CPT,300,RC,,,,BOTH,,,61,54.9,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,31.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.56,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.84,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.19,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,56.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.85,,,51.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,57.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,29.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,58.56,
HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL #,Px00030610373,CDM,87077,CPT,300,RC,,,,BOTH,,,61,54.9,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,31.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.56,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.84,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.19,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,56.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.85,,,51.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,57.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,29.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,58.56,
HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,Px00030600076,CDM,87077,CPT,300,RC,,,,BOTH,,,61,54.9,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,31.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.56,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.84,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.19,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,56.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.85,,,51.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,57.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,29.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,58.56,
HC WHIRLPOOL THERAPY,Px00042010117,CDM,97022,CPT,420,RC,,,,BOTH,,,61,54.9,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.58,,,47.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,31.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,50.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.56,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.84,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.19,,,47.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,56.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,31.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.85,,,51.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.95,,,54.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.9,,,57.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.89,,,29.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.58,58.56,
SODIUM HYPOCHLORITE SOLN 0.125%,Rx00436067216,CDM,,,250,RC,00436-0672-16,NDC,,BOTH,1,EA,61.11,55,58.05,,,55.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.67,,,47.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55,,,31.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55,,,50.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.94,,,31.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55,,,55.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.67,,,58.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.92,,,47.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.24,,,47.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.22,,,56.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.94,,,31.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.05,,,55.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55,,,58.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,29.94,,,29.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.67,58.67,
HC URINE CULTURE/COLONY COUNT,Px00030610417,CDM,87086,CPT,300,RC,,,,BOTH,,,61.26,55.13,58.2,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,60.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,39.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,73.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.03,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.32,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.36,,,70.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.07,,,65.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,73.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.02,,,30.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.78,58.81,
DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV),Rx00067815202,CDM,,,250,RC,00067-8152-02,NDC,,BOTH,1,EA,61.29,55.16,58.23,,,55.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.81,,,47.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.16,,,51.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.16,,,31.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.16,,,51.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.03,,,31.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.16,,,55.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.84,,,58.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.05,,,47.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.33,,,47.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.39,,,56.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.03,,,31.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.1,,,52.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.23,,,55.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.16,,,58.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.03,,,30.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.81,58.84,
CYCLOPENTOLATE HCL OPHTH SOLN 1%,Rx00065039605,CDM,,,250,RC,00065-0396-05,NDC,,BOTH,1,EA,61.41,54.83,58.34,,,55.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.9,,,47.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.27,,,51.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.27,,,31.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.27,,,51.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.09,,,31.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.27,,,55.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.95,,,58.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.14,,,47.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.39,,,47.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.5,,,56.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.09,,,31.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.2,,,52.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.34,,,55.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.27,,,58.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.09,,,30.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.9,58.95,
BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000,Rx63323046301,CDM,,,250,RC,63323-0463-01,NDC,,BOTH,1,EA,61.42,55.28,58.35,,,58.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.91,,,47.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.1,,,30.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.96,,,58.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.14,,,45.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.4,,,30.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.51,,,56.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.1,,,30.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.21,,,52.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.35,,,58.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.1,,,30.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.91,58.96,
SILVER SULFADIAZINE CREAM 1%,Rx59762013104,CDM,,,250,RC,59762-0131-04,NDC,,BOTH,1,EA,61.46,55.31,58.39,,,58.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,47.94,,,47.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.31,,,55.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.31,,,55.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.31,,,55.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.12,,,30.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.31,,,55.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,59,,,59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.17,,,45.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.42,,,30.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.54,,,56.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.12,,,30.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.24,,,52.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.39,,,58.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.31,,,55.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.12,,,30.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,47.94,59,
DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV),Rx45802095301,CDM,,,250,RC,45802-0953-01,NDC,,BOTH,1,EA,61.56,52,58.48,,,58.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.02,,,48.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.4,,,55.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.4,,,55.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.4,,,55.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.16,,,30.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.4,,,55.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,59.1,,,59.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.25,,,45.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.47,,,30.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.64,,,56.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.16,,,30.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.33,,,52.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.48,,,58.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.4,,,55.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.16,,,30.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.02,59.1,
HC PR 99462 NEWBORN HOSPITAL VISIT,Px00096910631,CDM,99462,CPT,987,RC,,,,BOTH,,,98,88.2,54.88,,,88.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.1,,,76.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,81.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,49.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,81.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.56,,,49.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.93,,,88.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,94.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,76.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,90.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.91,,,49.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,83.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,88.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.25,,,93.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,58.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,58.59,59.25,
HC PR 99231 SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES CDM,Px00098710011,CDM,99231,CPT,987,RC,,,,BOTH,,,90,81,50.4,,,81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.73,,,70.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.25,,,74.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.25,,,45.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.25,,,74.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.54,,,45.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.99,,,81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.5,,,86.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,70.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,82.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.85,,,45.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.3,,,76.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.25,,,85.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,59.25,
SILVER SULFADIAZINE CREAM 1%,Rx43598021040,CDM,,,250,RC,43598-0210-40,NDC,,BOTH,1,EA,61.97,46.17,58.87,,,58.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.34,,,48.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.77,,,55.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.77,,,55.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.77,,,55.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.37,,,30.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.77,,,55.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,59.49,,,59.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.55,,,45.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.67,,,30.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.01,,,57.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.37,,,30.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.67,,,52.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.87,,,58.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.77,,,55.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.37,,,30.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.34,59.49,
HC OVA AND PARASITES SMEARS,Px00030011200,CDM,87177,CPT,300,RC,,,,BOTH,,,62,55.8,58.9,,,55.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.36,,,48.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,51.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,31.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,51.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.38,,,31.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,55.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.52,,,59.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,48.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.68,,,48.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,57.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.38,,,31.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.7,,,52.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.9,,,55.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,58.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.38,,,30.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.36,59.52,
DOPAMINE INJ 1.6 MG/ML IN D5W,Rx00338100702,CDM,J1265,HCPCS,636,RC,338100702,NDC,,BOTH,1,ML,62.43,54.68,59.31,,,56.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.7,,,48.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.19,,,51.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.19,,,31.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.19,,,51.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,31.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.19,,,56.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.93,,,59.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.89,,,48.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,48.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.44,,,57.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,31.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.07,,,53.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.31,,,56.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.19,,,59.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.59,,,30.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.7,59.93,
NICARDIPINE HCL IV SOLN 2.5 MG/ML,Rx00143968910,CDM,J2404,HCPCS,636,RC,143968910,NDC,,BOTH,1,ML,62.5,68.53,59.38,,,59.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.75,,,48.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.25,,,56.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.25,,,56.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.25,,,56.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.63,,,30.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.25,,,56.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60,,,60,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.94,,,45.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,30.63,,,30.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.5,,,57.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.63,,,30.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.13,,,53.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,59.38,,,59.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.25,,,56.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,30.63,,,30.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.75,60,
HC 2 LAYER COMPRESSION SYSTEM 3M COBAN,Sx0000002094N,CDM,,,270,RC,,,,BOTH,,,62.57,102.6,59.44,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.8,,,48.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,31.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,31.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.07,,,60.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.99,,,48.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.97,,,48.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.56,,,57.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,31.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.18,,,53.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.44,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,59.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,30.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.8,60.07,
HC 2 LAYER LITE COMPRESSION SYS 3M COBAN,Sx0000002794N,CDM,,,270,RC,,,,BOTH,,,62.57,107.66,59.44,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.8,,,48.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,31.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,52.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,31.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.07,,,60.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.99,,,48.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.97,,,48.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.56,,,57.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,31.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.18,,,53.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.44,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.31,,,59.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.66,,,30.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,48.8,60.07,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML,Rx00548560700,CDM,J1650,HCPCS,636,RC,548560700,NDC,,BOTH,1,ML,62.98,56.68,59.83,,,56.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.12,,,49.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.68,,,52.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.68,,,32.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.68,,,52.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,32.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.68,,,56.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.46,,,60.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.29,,,49.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,49.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.94,,,58.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,32.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.53,,,53.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.83,,,56.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.68,,,60.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.86,,,30.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.12,60.46,
HC HOTLINE 3 WARMING SET - DISP,Sx000000L-370,CDM,,,270,RC,,,,BOTH,,,63.07,59.62,59.92,,,59.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.19,,,51.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,55.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,33.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,55.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.9,,,33.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,59.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.55,,,63.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.36,,,51.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.21,,,51.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,60.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.9,,,33.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.61,,,56.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.92,,,59.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,62.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,30.9,,,30.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.19,60.55,
HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE,Px00098311031,CDM,20600,CPT,983,RC,,,,BOTH,,,126,113.4,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.61,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.88,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.21,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,48.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.68,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.68,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.82,,,115.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.72,,,64.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.82,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,119.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.68,,,34.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,34.68,60.76,
HYDROXYZINE HCL IM SOLN 50 MG/ML,Rx00517560125,CDM,J3410,HCPCS,636,RC,517560125,NDC,,BOTH,1,ML,63.38,52.02,60.21,,,57.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.44,,,49.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,52.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,32.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,52.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.06,,,32.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,57.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.84,,,60.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.58,,,49.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.06,,,49.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.06,,,32.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.87,,,53.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,57.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.04,,,60.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.06,,,31.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.44,60.84,
HC GASES BLOOD PH ONLY #,Px00030100102,CDM,82800,CPT,300,RC,,,,BOTH,,,64,57.6,60.8,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,53.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,32.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,53.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,32.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.44,,,61.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,49.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.67,,,49.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.88,,,58.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,32.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,54.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,60.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,31.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.92,61.44,
HC OPERATING ROOM SERVICES LEVEL 2 PER MIN,Px00036010214,CDM,,,360,RC,,,,BOTH,,,64,57.6,60.8,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.92,,,49.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,53.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,32.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,53.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,32.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.44,,,61.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,49.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.67,,,49.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.88,,,58.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,32.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.4,,,54.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,57.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.6,,,60.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.36,,,31.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.92,61.44,
HC ASSAY OF ZINC,Px00030112242,CDM,84630,CPT,300,RC,,,,BOTH,,,64.24,57.82,61.03,,,57.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.11,,,50.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,53.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,32.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,53.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.48,,,32.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.67,,,61.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.22,,,50.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.79,,,50.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.1,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.48,,,32.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.6,,,54.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.03,,,57.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,61.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.48,,,31.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.11,61.67,
HC ASSAY OF INSULIN,Px00030112100,CDM,83525,CPT,300,RC,,,,BOTH,,,64.47,58.02,61.25,,,58.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.29,,,50.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,53.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,32.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,53.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.59,,,32.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,58.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.89,,,61.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.39,,,50.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.91,,,50.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.31,,,59.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.59,,,32.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.8,,,54.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,58.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.02,,,61.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.59,,,31.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.29,61.89,
RALTEGRAVIR POTASSIUM TAB 400 MG (BASE EQUIV),Rx00006022761,CDM,,,250,RC,00006-0227-61,NDC,,BOTH,400,ME,64.67,55.72,61.44,,,58.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.44,,,50.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,53.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,32.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,53.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,32.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,58.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.08,,,62.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,50.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.01,,,50.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.5,,,59.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,32.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.97,,,54.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.44,,,58.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,61.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,31.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.44,62.08,
HC K-WIRE 2X150MM TROCAR POINT,Sx00000390192,CDM,,,270,RC,,,,BOTH,,,64.68,58.21,61.45,,,58.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.45,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,53.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,32.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,53.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,32.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,58.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.09,,,62.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.54,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.01,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.51,,,59.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,32.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.98,,,54.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.45,,,58.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,61.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.69,,,31.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.45,62.09,
HC EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS,Px00047110105,CDM,92558,CPT,471,RC,,,,BOTH,,,65,49.5,61.75,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,42.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,28.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,45.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,52.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,50.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,28.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,46.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,49.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,52.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC BASIC METABOLIC PANEL,Px00030112061,CDM,80048,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100133,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100134,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100135,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100603,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100604,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100605,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100606,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,Px00030100607,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC GAMMAGLOBULIN IGA IGD IGG IGM EACH,Px00030014950,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,Px00030014951,CDM,82784,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC BLOOD CLOT INHIBITOR ASSAY,Px00030510043,CDM,85305,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH #,Px00030200274,CDM,86015,CPT,300,RC,,,,BOTH,,,65,58.5,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.7,,,50.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,33.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,54.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.78,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.17,,,50.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.8,,,59.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,33.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.25,,,55.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.75,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,61.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.85,,,31.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.7,62.4,
HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS #,Px00030200384,CDM,86258,CPT,300,RC,,,,BOTH,,,65.03,58.53,61.78,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.72,,,50.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,54.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,33.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,54.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,33.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.43,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.8,,,50.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.18,,,50.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.83,,,59.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,33.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.78,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,61.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,31.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.72,62.43,
HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS #,Px00030200385,CDM,86364,CPT,300,RC,,,,BOTH,,,65.03,58.53,61.78,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.72,,,50.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,54.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,33.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,54.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,33.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.43,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.8,,,50.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.18,,,50.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.83,,,59.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,33.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.28,,,55.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.78,,,58.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.53,,,61.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,31.86,,,31.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.72,62.43,
HC COMPRESSION WRAP-2 LAYER LITE,Px00012260WNH,CDM,,,270,RC,,,,BOTH,,,65.34,58.81,62.07,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.97,,,50.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,54.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,54.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,33.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.73,,,62.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,50.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,50.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.11,,,60.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,33.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.54,,,55.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.07,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,62.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,32.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.97,62.73,
HC COMPRESSION WRAP - 2 LAYER,Px00012259WNH,CDM,,,270,RC,,,,BOTH,,,65.34,58.81,62.07,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.97,,,50.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,54.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,33.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,54.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,33.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.73,,,62.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,50.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,50.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.11,,,60.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,33.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.54,,,55.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.07,,,58.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.81,,,62.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.02,,,32.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.97,62.73,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML,Rx00075802010,CDM,J1650,HCPCS,636,RC,75802010,NDC,,BOTH,1,ML,65.39,58.85,62.12,,,62.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51,,,51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.85,,,58.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.85,,,58.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.85,,,58.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.04,,,32.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.85,,,58.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.77,,,62.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.06,,,48.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.04,,,32.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.16,,,60.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.04,,,32.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.58,,,55.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.12,,,62.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.85,,,58.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.04,,,32.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51,62.77,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML,Rx00075802001,CDM,J1650,HCPCS,636,RC,75802001,NDC,,BOTH,1,ML,65.39,58.85,62.12,,,58.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51,,,51.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.85,,,54.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.85,,,33.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.85,,,54.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,33.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.85,,,58.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.77,,,62.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.06,,,51.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,51.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.16,,,60.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,33.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.58,,,55.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.12,,,58.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.85,,,62.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,32.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51,62.77,
HC PR ED 69210 REMOVE IMPACTED EAR WAX CDM,Px00098110831,CDM,69210,CPT,981,RC,,,,OUTPATIENT,,,114,102.6,63.84,,,102.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.17,,,88.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,138.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,138.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.78,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.88,,,102.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,45.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.11,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,31.11,,,88.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.98,,,104.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.04,,,58.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.98,,,96.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.84,,,102.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63,,,108.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.11,,,31.11,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,31.11,63,
HC PR ED 11740 DRAIN BLOOD FROM UNDER NAIL CDM,Px00098110253,CDM,11740,CPT,981,RC,,,,OUTPATIENT,,,134,120.6,75.04,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.94,,,104.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,153.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,153.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.58,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.7,,,44.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,104.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,104.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.38,,,123.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.66,,,68.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.38,,,113.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.04,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63,,,127.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.68,,,32.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.68,63,
HC FIBERWIRE 2-0 T-13 BLUE W/TPR 3/8 CIR NEEDLE AR-7220,Sx0000AR-7220,CDM,,,270,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL #,Px00030100628,CDM,83721,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC LDL CHOLESTEROL DIRECT,Px00030015375,CDM,83721,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL#,Px00030610303,CDM,87045,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA #,Px00030610751,CDM,87046,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,Px00030600081,CDM,87075,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ #,Px00030610547,CDM,87186,CPT,300,RC,,,,BOTH,,,66,59.4,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.48,,,51.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,33.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,54.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.36,,,63.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.66,,,51.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.72,,,60.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.1,,,56.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,59.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.4,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,63.36,
IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG,Rx63323032225,CDM,J0743,HCPCS,636,RC,63323032225,NDC,,BOTH,500,ME,66.01,59.45,62.71,,,59.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.49,,,51.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.41,,,54.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.41,,,33.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.41,,,54.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.41,,,59.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.37,,,63.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.52,,,51.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,51.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.73,,,60.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,33.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.11,,,56.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.71,,,59.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.41,,,62.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.49,63.37,
HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM,Px00098110529,CDM,20605,CPT,981,RC,,,,OUTPATIENT,,,150,135,84,,,135,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.4,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.75,,,164.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.75,,,164.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.02,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.68,,,135,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.5,,,50.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.67,,,117,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.67,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,138,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.74,,,76.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,127.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84,,,135,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,142.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.67,,,35.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,35.67,63.9,
IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG,Rx63323032201,CDM,J0743,HCPCS,636,RC,63323032201,NDC,,BOTH,500,ME,66.75,60.08,63.41,,,63.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.07,,,52.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.08,,,60.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.08,,,60.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.08,,,60.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.71,,,32.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.08,,,60.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.08,,,64.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.06,,,49.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,32.71,,,32.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.41,,,61.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.71,,,32.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.74,,,56.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.41,,,63.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.08,,,60.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,32.71,,,32.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.07,64.08,
HC COLLAR PHILADELPHIA - LARGE,Px00000276WNH,CDM,L0172,CPT,274,RC,,,,BOTH,,,66.9,60.21,63.56,,,60.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.18,,,52.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,55.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,34.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,55.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.78,,,34.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,60.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.22,,,64.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.17,,,52.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.11,,,52.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.55,,,61.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.78,,,34.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.87,,,56.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.56,,,60.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.21,,,63.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.78,,,32.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.18,64.22,
HC RENAL PANEL,Px00030112064,CDM,80069,CPT,300,RC,,,,BOTH,,,67,60.3,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.26,,,52.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,34.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.32,,,64.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.16,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.64,,,61.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,56.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,63.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,32.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.26,64.32,
HC ANTI-THROMBIN III,Px00030510151,CDM,85300,CPT,300,RC,,,,BOTH,,,67,60.3,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.26,,,52.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,34.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.32,,,64.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.16,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.64,,,61.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,56.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,63.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,32.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.26,64.32,
HC OPERATING ROOM SERVICES LEVEL 3 PER MIN,Px00036010216,CDM,,,360,RC,,,,BOTH,,,67,60.3,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.26,,,52.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,34.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,55.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.32,,,64.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.16,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.64,,,61.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,56.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.65,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.3,,,63.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,32.83,,,32.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.26,64.32,
SODIUM BICARBONATE IV SOLN 4.2%,Rx00409553434,CDM,,,250,RC,00409-5534-34,NDC,,BOTH,1,EA,67.5,60.75,64.13,,,64.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.65,,,52.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.75,,,60.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.75,,,60.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.75,,,60.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.08,,,33.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.75,,,60.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.61,,,49.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.41,,,33.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.1,,,62.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.08,,,33.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.38,,,57.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.13,,,64.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.75,,,60.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.08,,,33.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.65,64.8,
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM,Px00030610697,CDM,87449,CPT,300,RC,,,,BOTH,,,67.56,60.8,64.18,,,60.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.7,,,52.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,56.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,34.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,56.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.1,,,34.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,60.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.86,,,64.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.66,,,52.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,52.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.16,,,62.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.1,,,34.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.43,,,57.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.18,,,60.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.8,,,64.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.1,,,33.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.7,64.86,
HC C DIFFICILE TOXIN,Px00030310165,CDM,87324,CPT,300,RC,,,,BOTH,,,67.57,60.81,64.19,,,60.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.7,,,52.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.81,,,56.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.81,,,34.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.81,,,56.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.11,,,34.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.81,,,60.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.87,,,64.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.66,,,52.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.44,,,52.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.16,,,62.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.11,,,34.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.43,,,57.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,60.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.81,,,64.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.11,,,33.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.7,64.87,
TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML,Rx00409656201,CDM,J1071,HCPCS,636,RC,409656201,NDC,,BOTH,1,ML,67.83,44.1,64.44,,,64.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,,,52.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.24,,,33.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.12,,,65.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.86,,,49.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.24,,,33.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.24,,,33.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.66,,,57.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.44,,,64.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.24,,,33.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.91,65.12,
DEXTROSE INJ 5%,Rx00264751010,CDM,J7060,HCPCS,636,RC,264751010,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 3%,Rx00264780510,CDM,J7131,HCPCS,636,RC,264780510,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 5%,Rx00338001702,CDM,J7060,HCPCS,636,RC,338001702,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 5%,Rx00338001703,CDM,J7060,HCPCS,636,RC,338001703,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004902,CDM,J7050,HCPCS,636,RC,338004902,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004938,CDM,J7050,HCPCS,636,RC,338004938,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004941,CDM,J7050,HCPCS,636,RC,338004941,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004948,CDM,J7050,HCPCS,636,RC,338004948,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 3%,Rx00338005403,CDM,J7131,HCPCS,636,RC,338005403,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338055318,CDM,J7050,HCPCS,636,RC,338055318,NDC,,BOTH,500,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ",Rx00338069104,CDM,J3480,HCPCS,636,RC,338069104,NDC,,BOTH,100,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%,Rx00409765052,CDM,J1644,HCPCS,636,RC,409765052,NDC,,BOTH,250,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%,Rx00409765062,CDM,J1644,HCPCS,636,RC,409765062,NDC,,BOTH,250,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%,Rx63323051774,CDM,J1644,HCPCS,636,RC,63323051774,NDC,,BOTH,250,ML,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HETASTARCH IN SODIUM CHLORIDE INJ 6-0.9%,Rx00264196510,CDM,,,250,RC,00264-1965-10,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ,Rx00264763500,CDM,,,250,RC,00264-7635-00,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IRRIGATION SOLN 0.9%,Rx00338004727,CDM,,,250,RC,00338-0047-27,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IRRIGATION SOLN 0.9%,Rx00338004803,CDM,,,250,RC,00338-0048-03,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx00409490234,CDM,,,250,RC,00409-4902-34,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx00409490264,CDM,,,250,RC,00409-4902-64,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
ACETIC ACID IRRIGATION SOLN 0.25%,Rx00409614322,CDM,,,250,RC,00409-6143-22,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx00409751716,CDM,,,250,RC,00409-7517-16,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ,Rx00990790209,CDM,,,250,RC,00990-7902-09,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx76329330101,CDM,,,250,RC,76329-3301-01,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx76329330201,CDM,,,250,RC,76329-3302-01,NDC,,BOTH,1,EA,68,61.2,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,33.65,,,33.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,Rx00264958720,CDM,J1644,HCPCS,636,RC,264958720,NDC,,BOTH,1,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 5%,Rx00338001704,CDM,J7060,HCPCS,636,RC,338001704,NDC,,BOTH,500,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 5%,Rx00338001748,CDM,J7060,HCPCS,636,RC,338001748,NDC,,BOTH,500,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004903,CDM,J7050,HCPCS,636,RC,338004903,NDC,,BOTH,500,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.9%,Rx00338004904,CDM,J7050,HCPCS,636,RC,338004904,NDC,,BOTH,500,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%,Rx00338008904,CDM,J7042,HCPCS,636,RC,338008904,NDC,,BOTH,500,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
LACTATED RINGER'S SOLUTION,Rx00338011704,CDM,J7120,HCPCS,636,RC,338011704,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML,Rx00338041102,CDM,J2001,HCPCS,636,RC,338041102,NDC,,BOTH,1,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ",Rx00990711509,CDM,J3480,HCPCS,636,RC,990711509,NDC,,BOTH,100,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%,Rx63323051701,CDM,J1644,HCPCS,636,RC,63323051701,NDC,,BOTH,250,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 3%,Rx63323053021,CDM,J7131,HCPCS,636,RC,63323053021,NDC,,BOTH,1,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 10%,Rx00338002304,CDM,,,250,RC,00338-0023-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IV SOLN 0.45%,Rx00338004304,CDM,,,250,RC,00338-0043-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
SODIUM CHLORIDE IRRIGATION SOLN 0.9%,Rx00338004804,CDM,,,250,RC,00338-0048-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%",Rx00338007704,CDM,,,250,RC,00338-0077-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,Rx00338008504,CDM,,,250,RC,00338-0085-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ,Rx00338067104,CDM,,,250,RC,00338-0671-04,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
DEXTROSE INJ 50%,Rx00409751766,CDM,,,250,RC,00409-7517-66,NDC,,BOTH,1,EA,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML,Rx10019067010,CDM,,,250,RC,10019-0670-10,NDC,,BOTH,250,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
POTASSIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 22 MEQ/5ML (K),Rx65219005209,CDM,,,250,RC,65219-0052-09,NDC,,BOTH,5,ML,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HC CLOTTING INHIBITORS PROTEIN C ANTIGEN #,Px00030510046,CDM,85302,CPT,300,RC,,,,BOTH,,,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB #,Px00030200358,CDM,86037,CPT,300,RC,,,,BOTH,,,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB #,Px00030200365,CDM,86037,CPT,300,RC,,,,BOTH,,,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB #,Px00030200366,CDM,86037,CPT,300,RC,,,,BOTH,,,68,61.2,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.04,,,53.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,34.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,56.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.28,,,65.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.65,,,53.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.56,,,62.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,34.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.8,,,57.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.32,,,33.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.04,65.28,
PHENOBARBITAL SODIUM INJ 65 MG/ML,Rx42494041525,CDM,J2560,HCPCS,636,RC,42494041525,NDC,,BOTH,1,ML,68.06,61.29,64.66,,,61.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.09,,,53.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,56.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,34.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,56.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.35,,,34.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.34,,,65.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.02,,,53.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.35,,,53.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.62,,,62.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.35,,,34.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.85,,,57.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.66,,,61.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,64.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.35,,,33.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.09,65.34,
HC EVACUATED CONTAINER 2000ML,Px00001106WNH,CDM,,,270,RC,,,,BOTH,,,68.1,61.29,64.7,,,61.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.12,,,53.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,56.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,34.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,56.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,34.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,61.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.38,,,65.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.05,,,53.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.7,,,53.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.65,,,62.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,34.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.89,,,57.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.7,,,61.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,64.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,33.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.12,65.38,
"HC NEEDLE NERVE BLOOCK 225GA X 2""",Px00009998WNH,CDM,,,270,RC,,,,BOTH,,,68.1,61.29,64.7,,,61.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.12,,,53.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,56.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,34.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,56.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,34.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,61.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.38,,,65.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.05,,,53.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.7,,,53.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.65,,,62.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,34.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.89,,,57.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.7,,,61.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,64.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.37,,,33.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.12,65.38,
"HC PR ED 98925 OSTEOPATHIC MANIP,1-2 BODY REGN CDM",Px00098110971,CDM,98925,CPT,981,RC,,,,OUTPATIENT,,,95,85.5,53.2,,,85.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.14,,,74.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.38,,,125.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.38,,,125.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.47,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.21,,,85.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.25,,,28.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.15,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22.15,,,74.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,87.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.81,,,48.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.15,,,80.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.2,,,85.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.38,,,90.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,22.15,,,22.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,22.15,65.38,
HC EAR WICK POPE MEROCEL,Sx00000400146,CDM,,,270,RC,,,,BOTH,,,68.4,61.56,64.98,,,61.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.35,,,53.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.56,,,56.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.56,,,34.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.56,,,56.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.52,,,34.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.56,,,61.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.66,,,65.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.27,,,53.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,33.85,,,53.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.93,,,62.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.52,,,34.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.14,,,58.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.98,,,61.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.56,,,64.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.52,,,33.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.35,65.66,
HC COMPRESSION SLEEVE BLUE MED CALF,Sx000MDS601M2,CDM,,,270,RC,,,,BOTH,,,68.88,61.99,65.44,,,62.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.73,,,53.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.99,,,57.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.99,,,35.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.99,,,57.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.75,,,35.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.99,,,62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.12,,,66.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,53.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.09,,,53.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.37,,,63.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.75,,,35.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.55,,,58.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.44,,,62.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.99,,,65.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.75,,,33.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.73,66.12,
HC PR 36620 ANES/ARTERIAL CATH/CANNULA,Px00096310223,CDM,36620,CPT,975,RC,,,,BOTH,,,55,49.5,30.8,,,49.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.36,,,42.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.38,,,45.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.38,,,28.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.38,,,45.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.98,,,28.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.49,,,49.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.25,,,52.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,42.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,42.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,50.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.97,,,28.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.35,,,46.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.8,,,49.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,52.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,14.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,14.31,66.15,
HC PR ED 36620 INSERTION CATHETER ARTERY CDM,Px00098110499,CDM,36620,CPT,981,RC,,,,OUTPATIENT,,,103,92.7,57.68,,,92.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.36,,,80.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.38,,,85.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.38,,,52.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.38,,,85.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,52.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.49,,,92.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.65,,,98.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,80.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.71,,,94.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,52.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.71,,,87.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.68,,,92.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,97.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,14.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,14.31,66.15,
HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED#,Px00030200356,CDM,86671,CPT,300,RC,,,,BOTH,,,69,62.1,65.55,,,62.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.82,,,53.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.1,,,57.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.1,,,35.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.1,,,57.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.1,,,62.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.72,,,53.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.15,,,53.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.48,,,63.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,35.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.65,,,58.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.55,,,62.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.1,,,65.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.81,,,33.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,66.24,
HC HEP A ANTIBODY IGM,Px00030010931,CDM,86709,CPT,300,RC,,,,BOTH,,,69.26,62.33,65.8,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.94,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.49,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.91,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.28,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.72,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.94,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.87,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.8,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.94,,,33.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.02,66.49,
HC BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT #,Px00030510009,CDM,85060,CPT,300,RC,,,,BOTH,,,69.3,62.37,65.84,,,62.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.05,,,54.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.37,,,57.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.37,,,35.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.37,,,57.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.96,,,35.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.37,,,62.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.53,,,66.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.94,,,54.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.3,,,54.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.76,,,63.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.96,,,35.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.91,,,58.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.84,,,62.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.37,,,65.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,33.96,,,33.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.05,66.53,
HC NEEDLE NERVE BLOCK 22GA X 2 IN SINGLE SHOT ECHOGENINC,Sx00000333642,CDM,,,270,RC,,,,BOTH,,,69.67,76.16,66.19,,,62.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.34,,,54.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,35.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.14,,,35.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,62.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.88,,,66.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.21,,,54.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.48,,,54.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.1,,,64.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.14,,,35.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.22,,,59.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.19,,,62.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.7,,,66.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.14,,,34.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.34,66.88,
HC PR 00836 ANESTH HERNIA REPAIR PREEMIE QZ,Px00096310213,CDM,836,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
HC PR 00944 ANESTH VAGINAL HYSTERECTOMY,Px00096310106,CDM,944,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
HC PR 00732 ANES UPR GI NDSC PX ERCP,Px00096310283,CDM,732,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
HC PR 00832 ANESTH REPAIR OF HERNIA VENTRI&INCISION,Px00096310073,CDM,832,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,64.67,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
HC PR 01210 ANESTH HIP JOINT SURGERY,Px00096310114,CDM,1210,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,90.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,80.84,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
HC PR 00752 ANESTH REPAIR OF HERNIA VENTRIL &INCISION,Px00096310060,CDM,752,CPT,963,RC,,,,BOTH,,,103.2,92.88,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.7,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.5,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.76,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.73,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.82,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.79,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.26,,,121.26,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.5,67.08,BASE FEE
NALOXONE HCL NASAL SPRAY 4 MG/0.1ML,Rx69547035302,CDM,,,250,RC,69547-0353-02,NDC,,BOTH,0.1,ML,69.9,63.1,66.41,,,66.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.52,,,54.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.91,,,62.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.91,,,62.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.91,,,62.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.25,,,34.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.91,,,62.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.1,,,67.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.38,,,51.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.59,,,34.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.31,,,64.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.25,,,34.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.42,,,59.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,66.41,,,66.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.91,,,62.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.25,,,34.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.52,67.1,
HC BILL SURG LEVEL 3,Px00031010234,CDM,88304,CPT,300,RC,,,,BOTH,,,70,63,66.5,,,63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.6,,,54.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63,,,58.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63,,,35.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63,,,58.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.3,,,35.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63,,,63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.2,,,67.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,54.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.64,,,54.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.4,,,64.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.3,,,35.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.5,,,59.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63,,,66.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.3,,,34.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.6,67.2,
HC COMPRESSION SLEEVE VASOPRSS BLUE BARIATRIC CALF,Sx00000VP501B,CDM,,,270,RC,,,,BOTH,,,70.02,63.02,66.52,,,63.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.62,,,54.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.02,,,58.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.02,,,35.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.02,,,58.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.31,,,35.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.02,,,63.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.22,,,67.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.46,,,54.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.65,,,54.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.42,,,64.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.31,,,35.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.52,,,59.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.52,,,63.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.02,,,66.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.31,,,34.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.62,67.22,
ULIPRISTAL ACETATE TAB 30 MG,Rx50102091101,CDM,,,250,RC,50102-0911-01,NDC,,BOTH,30,ME,70.04,63.04,66.54,,,66.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.63,,,54.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.04,,,63.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.04,,,63.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.04,,,63.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,,,34.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.04,,,63.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.24,,,67.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.48,,,51.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,34.66,,,34.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.44,,,64.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,,,34.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.53,,,59.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,66.54,,,66.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.04,,,63.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,34.32,,,34.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,54.63,67.24,
HC PR APPLICATION OF UNAL BOOT BIL,Px00097510477,CDM,29580,CPT,983,RC,,,,BOTH,,,153,137.7,85.68,,,85.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,32.4,,,32.4,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,95.63,,,95.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,95.63,,,95.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,95.63,,,95.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.97,,,28.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,34.28,,,34.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.15,,,84.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.19,,,25.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,25.19,,,25.19,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,87.21,,,87.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.95,,,25.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,87.21,,,87.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,85.68,,,85.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,67.5,,,67.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.19,,,25.19,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.19,67.5,
HC PR 29580 STRAPPING UNNA BOOT  CDM,Px00098311368,CDM,29580,CPT,983,RC,,,,BOTH,,,82,73.8,45.92,,,73.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.4,,,63.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.25,,,65.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.25,,,29.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.25,,,65.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.97,,,29.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.28,,,73.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.1,,,78.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.19,,,63.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.19,,,63.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,75.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.95,,,29.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.92,,,73.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,77.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.19,,,25.19,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.19,67.5,
HC HAPTOGLOBIN.,Px00030015036,CDM,83010,CPT,300,RC,,,,BOTH,,,71,63.9,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.38,,,55.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,36.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.16,,,68.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.19,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.32,,,65.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.35,,,60.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,67.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,34.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.38,68.16,
HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE #,Px00030500039,CDM,85461,CPT,300,RC,,,,BOTH,,,71,63.9,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.38,,,55.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,36.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.16,,,68.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.19,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.32,,,65.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.35,,,60.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,67.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,34.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.38,68.16,
HC BILL SURG LEVEL 4,Px00031010235,CDM,88305,CPT,300,RC,,,,BOTH,,,71,63.9,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.38,,,55.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,36.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,59.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.16,,,68.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.19,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,55.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.32,,,65.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,36.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.35,,,60.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.45,,,63.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,67.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,34.79,,,34.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.38,68.16,
HC DRESSING ASHERMAN SEAL SELF ADH ONE WAY VALVE,Sx00000849100,CDM,,,270,RC,,,,BOTH,,,71.46,64.31,67.89,,,64.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.74,,,55.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,59.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,36.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,59.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.02,,,36.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,64.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.6,,,68.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.52,,,55.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.37,,,55.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.74,,,65.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.02,,,36.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.74,,,60.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.89,,,64.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,67.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.02,,,35.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.74,68.6,
NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,Rx70069026101,CDM,,,250,RC,70069-0261-01,NDC,,BOTH,1,ML,71.61,64.51,68.03,,,68.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.86,,,55.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.45,,,64.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.45,,,64.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.45,,,64.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.09,,,35.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.45,,,64.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,68.75,,,68.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.63,,,52.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,35.44,,,35.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.88,,,65.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.09,,,35.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.87,,,60.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,68.03,,,68.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.45,,,64.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,35.09,,,35.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.86,68.75,
HC ZINC SERUM,Px00030016230,CDM,84630,CPT,300,RC,,,,BOTH,,,71.62,64.46,68.04,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,61.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.46,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.46,,,40.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.46,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.09,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.46,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.76,,,75.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.64,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.44,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.89,,,72.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.09,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.88,,,67.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.04,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.46,,,75.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.09,,,35.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.86,68.76,
HC BINDER ABDOMINAL XLG 418 9 INWIDE 3 PANEL 60 IN TO 75,Sx00013993000,CDM,,,270,RC,,,,BOTH,,,71.91,102.55,68.31,,,102.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.09,,,88.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.72,,,94.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.72,,,58.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.72,,,94.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.24,,,58.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.72,,,102.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.03,,,109.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.85,,,88.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.59,,,88.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.16,,,104.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.24,,,58.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.12,,,96.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,102.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.72,,,108.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.24,,,35.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.09,69.03,
HC ASSAY OF L7383TRANSFERRIN #,Px00030100901,CDM,84466,CPT,300,RC,,,,BOTH,,,71.97,64.77,68.37,,,64.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.14,,,56.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.77,,,59.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.77,,,36.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.77,,,59.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.27,,,36.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.77,,,64.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.9,,,56.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.62,,,56.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.21,,,66.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.27,,,36.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.17,,,61.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,64.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.77,,,68.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.27,,,35.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.14,69.09,
HC MESH 3X6 IN FLAT HERNIA HERNIAMESH STYLE 6 LIGHT,Sx00000H60815,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST #,Px00030600083,CDM,87106,CPT,300,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
HC IAAD IA HEPATITIS B SURFACE ANTIGEN #,Px00030600380,CDM,87340,CPT,300,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
HC IAAD IA HEPATITIS B SURFACE ANTIGEN #,Px00030600431,CDM,87340,CPT,300,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
HC IAAD IA HEPATITIS B SURFACE ANTIGEN #,Px00030600432,CDM,87340,CPT,300,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
HC HEPATITIS B SURFACE ANTIGEN,Px00030011646,CDM,87340,CPT,300,RC,,,,BOTH,,,72,64.8,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,36.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,69.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.63,,,56.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.24,,,66.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.2,,,61.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,64.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.8,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.16,69.12,
CEFAZOLIN SODIUM FOR IV SOLN 2 GM AND DEXTROSE 3% (50 ML),Rx00264310511,CDM,J0690,HCPCS,636,RC,264310511,NDC,,BOTH,50,ML,72.01,57.65,68.41,,,64.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.17,,,56.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.81,,,59.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.81,,,36.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.81,,,59.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.81,,,64.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.13,,,69.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.93,,,56.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,56.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.25,,,66.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,36.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.21,,,61.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.41,,,64.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.81,,,68.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,35.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.17,69.13,
HC PR 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,Px00098300270,CDM,11000,CPT,983,RC,,,,BOTH,,,137,123.3,76.72,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.46,,,106.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,114.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,69.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,114.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.87,,,69.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.92,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.35,,,131.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,106.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.09,,,126.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.75,,,69.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.09,,,116.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.72,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,130.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.97,,,25.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.97,69.3,
"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",Rx63323026969,CDM,J2704,HCPCS,636,RC,63323026969,NDC,,BOTH,1,ML,72.22,65,68.61,,,65.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.33,,,56.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65,,,60.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65,,,36.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65,,,60.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.39,,,36.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65,,,65.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.33,,,69.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.08,,,56.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.39,,,56.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.44,,,66.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.39,,,36.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.39,,,61.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.61,,,65.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65,,,68.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.39,,,35.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.33,69.33,
HC CALCULUS SPECTROSCOPY,Px00030112138,CDM,82365,CPT,300,RC,,,,BOTH,,,72.63,65.37,69,,,65.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.65,,,56.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.37,,,60.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.37,,,37.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.37,,,60.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.59,,,37.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.37,,,65.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.72,,,69.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.38,,,56.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,56.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.82,,,66.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.59,,,37.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69,,,65.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.37,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.59,,,35.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.65,69.72,
HC CATH IV ANGIO 10X3.0,Sx00000382287,CDM,,,270,RC,,,,BOTH,,,72.82,65.54,69.18,,,65.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.8,,,56.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.54,,,60.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.54,,,37.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.54,,,60.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.68,,,37.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.54,,,65.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.91,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.52,,,56.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.04,,,56.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.99,,,67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.68,,,37.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.9,,,61.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.18,,,65.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.54,,,69.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.68,,,35.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.8,69.91,
HC PAD HYPOTHERMIA 13x18 DISPOSABLE,Sx8002-062-01,CDM,,,270,RC,,,,BOTH,,,73.35,57.92,69.68,,,66.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.21,,,57.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.02,,,61.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.02,,,37.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.02,,,61.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,37.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.02,,,66.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.42,,,70.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.91,,,57.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.3,,,57.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.48,,,67.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,37.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.35,,,62.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.68,,,66.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.02,,,69.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,35.94,,,35.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.21,70.42,
HC PAD INFANT WARMER 10X16 IN DISPOSABLE,Sx0000MDS1017,CDM,,,270,RC,,,,BOTH,,,73.59,66.23,69.91,,,66.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.4,,,57.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.23,,,61.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.23,,,37.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.23,,,61.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.06,,,37.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.23,,,66.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.09,,,57.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.42,,,57.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.7,,,67.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.06,,,37.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.55,,,62.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.91,,,66.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.23,,,69.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.06,,,36.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.4,70.65,
HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM,Px00098110525,CDM,20552,CPT,981,RC,,,,OUTPATIENT,,,126,113.4,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.49,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.74,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.16,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,51.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.43,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,35.43,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.82,,,115.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.49,,,64.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.82,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,119.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.43,,,35.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,35.43,70.65,
NALOXONE 4 MG/0.1ML NASAL LIQUID (PREPACK - OR),Rx00000002689,CDM,,,250,RC,00000-0026-89,NDC,,BOTH,1,EA,73.86,66.47,70.17,,,66.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.61,,,57.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,61.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,37.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,61.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,37.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,66.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.91,,,70.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.29,,,57.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.55,,,57.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.95,,,67.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,37.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.78,,,62.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.17,,,66.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,70.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,36.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.61,70.91,
HC LUMBAR PUNCTURE - ADULT,Px00000371WNH,CDM,,,270,RC,,,,BOTH,,,73.86,66.47,70.17,,,66.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.61,,,57.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,61.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,37.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,61.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,37.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,66.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.91,,,70.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.29,,,57.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.55,,,57.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.95,,,67.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,37.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.78,,,62.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.17,,,66.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.47,,,70.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.19,,,36.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.61,70.91,
WOUND DRESSINGS - PASTE,Rx09958003361,CDM,,,250,RC,09958-0033-61,NDC,,BOTH,1,EA,73.89,78.05,70.2,,,78.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.63,,,67.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,44.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.21,,,44.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,78.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.93,,,83.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.31,,,67.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.57,,,67.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.98,,,79.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.21,,,44.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.81,,,73.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,78.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.5,,,82.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.21,,,36.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.63,70.93,
HC MATTRESS DECUBITUS CARE PAD,Px00000905WNH,CDM,,,270,RC,,,,BOTH,,,73.98,66.58,70.28,,,66.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.7,,,57.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,61.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,37.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,61.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,37.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,66.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.02,,,71.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.38,,,57.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.61,,,57.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.06,,,68.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,37.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.88,,,62.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.28,,,66.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,70.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.25,,,36.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.7,71.02,
HC GLYCOSYLATED HEMOGLOBIN,Px00030015020,CDM,83036,CPT,300,RC,,,,BOTH,,,74,66.6,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.72,,,57.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,37.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.04,,,71.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.08,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.9,,,62.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,70.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,36.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.72,71.04,
HC ANTIBODY SCREEN,Px00030211093,CDM,86850,CPT,300,RC,,,,BOTH,,,74,66.6,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.72,,,57.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,37.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.04,,,71.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.08,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.9,,,62.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,70.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,36.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.72,71.04,
HC COOMBS TEST DIRECT - DAT IGG,Px00030011073,CDM,86880,CPT,300,RC,,,,BOTH,,,74,63,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.72,,,57.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,37.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,61.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.04,,,71.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,57.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.08,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,37.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.9,,,62.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.3,,,66.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.6,,,70.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.26,,,36.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.72,71.04,
HC PR ED 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM,Px00098110818,CDM,65205,CPT,981,RC,,,,OUTPATIENT,,,116,104.4,64.96,,,104.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.37,,,90.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.5,,,96.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.5,,,59.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.5,,,96.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.41,,,59.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.42,,,104.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.8,,,111.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.18,,,90.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.18,,,90.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.12,,,106.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.03,,,59.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.12,,,98.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.96,,,104.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,110.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.18,,,28.18,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.18,71.1,
HC ECHOBRIGHT 20GA X 100MM BLOCK,Px00011000WNH,CDM,,,270,RC,,,,BOTH,,,74.4,66.96,70.68,,,66.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.03,,,58.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.96,,,61.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.96,,,37.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.96,,,61.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,37.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.96,,,66.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.42,,,71.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.68,,,58.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.82,,,58.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.45,,,68.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,37.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.24,,,63.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.68,,,66.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.96,,,70.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.46,,,36.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.03,71.42,
DIAZEPAM INJ 5 MG/ML,Rx00409127303,CDM,J3360,HCPCS,636,RC,409127303,NDC,,BOTH,1,ML,74.45,67.01,70.73,,,67.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.07,,,58.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.01,,,61.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.01,,,37.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.01,,,61.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,37.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.01,,,67.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.47,,,71.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.72,,,58.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,58.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.49,,,68.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,37.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.28,,,63.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.73,,,67.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.01,,,70.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.48,,,36.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.07,71.47,
DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV),Rx69097052444,CDM,,,250,RC,69097-0524-44,NDC,,BOTH,1,EA,74.52,45.2,70.79,,,70.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.13,,,58.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.07,,,67.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.07,,,67.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.07,,,67.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.51,,,36.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.07,,,67.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.54,,,71.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.77,,,54.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.88,,,36.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.56,,,68.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.51,,,36.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.34,,,63.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.79,,,70.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.07,,,67.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.51,,,36.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.13,71.54,
MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),Rx63323010603,CDM,J3475,HCPCS,636,RC,63323010603,NDC,,BOTH,50,ML,74.58,67.12,70.85,,,70.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.17,,,58.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.12,,,67.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.12,,,67.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.12,,,67.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.54,,,36.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.12,,,67.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.6,,,71.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.82,,,54.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,36.54,,,36.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.61,,,68.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.54,,,36.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.39,,,63.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.85,,,70.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.12,,,67.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.54,,,36.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.17,71.6,
HC DRUG SCREEN QUANTITATIVE ZONISAMIDE #,Px00030110136,CDM,80203,CPT,300,RC,,,,BOTH,,,74.73,67.26,70.99,,,67.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,58.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.26,,,62.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.26,,,38.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.26,,,62.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,38.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.26,,,67.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.74,,,71.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,58.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.98,,,58.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.75,,,68.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,38.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.52,,,63.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,67.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.26,,,70.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.62,,,36.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.29,71.74,
HC CERULOPLASMIN.,Px00030014527,CDM,82390,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC ASSAY OF CPK IN BLOOD,Px00030013052,CDM,82552,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM #,Px00030100644,CDM,84165,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC PROT ELP-PROTEIN ELP SERUM,Px00030015763,CDM,84165,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC HEP B SURFACE AB,Px00030210735,CDM,86706,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC HEPATITIS B SURF ANTIBODY HBSAB #,Px00030200682,CDM,86706,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
HC HEPATITIS B SURF ANTIBODY HBSAB #,Px00030200686,CDM,86706,CPT,300,RC,,,,BOTH,,,75,67.5,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.5,,,58.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,38.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,62.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.12,,,58.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69,,,69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,38.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.75,,,63.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.25,,,67.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.5,,,71.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.75,,,36.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.5,72,
"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)",Rx63323088401,CDM,,,250,RC,63323-0884-01,NDC,,BOTH,5,ML,75.16,67.64,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.62,,,58.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.64,,,67.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.64,,,67.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.64,,,67.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.83,,,36.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.64,,,67.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.15,,,72.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.24,,,55.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,37.2,,,37.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.15,,,69.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.83,,,36.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.89,,,63.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.64,,,67.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,36.83,,,36.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.62,72.15,
ULIPRISTAL ACETATE TAB 30 MG,Rx73302045601,CDM,,,250,RC,73302-0456-01,NDC,,BOTH,30,ME,75.3,67.82,71.54,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.73,,,58.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,62.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,38.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,62.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.29,,,72.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.35,,,58.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.27,,,58.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.28,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.01,,,64.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,71.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.73,72.29,
MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED),Rx78206011403,CDM,,,250,RC,78206-0114-03,NDC,,BOTH,0.22,ME,75.3,135.71,71.54,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.73,,,58.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,62.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,38.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,62.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.29,,,72.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.35,,,58.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.27,,,58.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.28,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,38.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.01,,,64.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,67.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.77,,,71.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,36.9,,,36.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.73,72.29,
HC NEEDLE NERVE BLOCK 22GA X 4 IN SINGLE SHOT ECHOGENIC,Sx00000333656,CDM,,,270,RC,,,,BOTH,,,75.63,68.07,71.85,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.99,,,59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.07,,,62.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.07,,,38.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.07,,,62.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.06,,,38.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.07,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.6,,,72.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.59,,,59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.43,,,59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,69.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.06,,,38.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.29,,,64.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.85,,,68.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.07,,,71.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.06,,,37.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,58.99,72.6,
HC ALPHA-1-ANTITRYPSIN TOTAL #,Px00030112022,CDM,82103,CPT,300,RC,,,,BOTH,,,75.8,68.22,72.01,,,68.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.12,,,59.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.22,,,63.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.22,,,38.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.22,,,63.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.14,,,38.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.22,,,68.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,72.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.71,,,59.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.51,,,59.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.74,,,69.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.14,,,38.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.43,,,64.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.01,,,68.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.22,,,72.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.14,,,37.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.12,72.77,
HC K WIRE THREADED ZIMMER .062,Sx47026201300,CDM,,,270,RC,,,,BOTH,,,75.9,76.09,72.11,,,68.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.2,,,59.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,63.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,38.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,63.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.19,,,38.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,68.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.86,,,72.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.79,,,59.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.56,,,59.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,69.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.19,,,38.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.52,,,64.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.11,,,68.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.31,,,72.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.19,,,37.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.2,72.86,
HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM,Px00098110489,CDM,99282,CPT,981,RC,,,,OUTPATIENT,,,99,89.1,55.44,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.98,,,77.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,82.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,50.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,82.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.68,,,50.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.35,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.45,,,95.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,77.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.43,,,91.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,50.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.46,,,84.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.44,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.88,,,94.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,72.88,
HC MASK NASAL DISP SM CONTOUR DELUXE,Sx98980561025,CDM,,,270,RC,,,,BOTH,,,75.97,68.37,72.17,,,68.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.26,,,59.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,63.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,38.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,63.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.23,,,38.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,68.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,72.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.84,,,59.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.6,,,59.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.89,,,69.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.23,,,38.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.57,,,64.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.17,,,68.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.37,,,72.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.23,,,37.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.26,72.93,
HC CREATININE CLEARANCE-SERUM + URINE,Px00030014631,CDM,82575,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC LACTATE (LACTIC ACID),Px00030015357,CDM,83605,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC ASSAY OF LEAD #,Px00030100624,CDM,83655,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC ASSAY OF LEAD #,Px00030100625,CDM,83655,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC ASSAY OF LEAD #,Px00030100766,CDM,83655,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC LEAD BLOOD,Px00030015376,CDM,83655,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
HC LIPOPROTEIN HDL,Px00030015059,CDM,83718,CPT,300,RC,,,,BOTH,,,76,68.4,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.28,,,59.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,38.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,63.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.96,,,72.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.61,,,59.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.92,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,38.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.6,,,64.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.2,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.4,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.24,,,37.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.28,72.96,
ESMOLOL HCL INJ 100 MG/10ML,Rx10019012039,CDM,,,250,RC,10019-0120-39,NDC,,BOTH,10,ML,76.07,68.46,72.27,,,68.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.33,,,59.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.46,,,63.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.46,,,38.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.46,,,63.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.27,,,38.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.46,,,68.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.03,,,73.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.91,,,59.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.65,,,59.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.98,,,69.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.27,,,38.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.66,,,64.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,68.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.46,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.27,,,37.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.33,73.03,
"HC NEEDLE NERVE BLOCK 20GA X 4""",Px00011369WNH,CDM,,,270,RC,,,,BOTH,,,76.5,68.85,72.68,,,68.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.67,,,59.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,63.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,38.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,63.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,38.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,68.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.44,,,73.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.23,,,59.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.86,,,59.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.38,,,70.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,38.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.03,,,65.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.68,,,68.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,72.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.49,,,37.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.67,73.44,
SODIUM BICARBONATE IV SOLN 8.4%,Rx63323008950,CDM,,,250,RC,63323-0089-50,NDC,,BOTH,1,EA,76.78,60.75,72.94,,,72.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,59.89,,,59.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.1,,,69.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.1,,,69.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.1,,,69.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.62,,,37.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.1,,,69.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,73.71,,,73.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.43,,,56.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38,,,38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.64,,,70.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.62,,,37.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.26,,,65.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.94,,,72.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.1,,,69.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,37.62,,,37.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,59.89,73.71,
HC ED OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS CDM,Px00045011008,CDM,98925,CPT,450,RC,,,,OUTPATIENT,,,77,54.9,73.15,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.06,,,52.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,105.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,105.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.92,,,28.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.6,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.11,,,52.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.84,,,61.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,34.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.45,,,56.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.15,,,60.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,63.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,37.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.06,73.92,
HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE #,Px00030600372,CDM,87086,CPT,300,RC,,,,BOTH,,,77,69.3,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.06,,,60.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,39.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.92,,,73.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.6,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.11,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.84,,,70.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.45,,,65.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,73.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,37.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.06,73.92,
HC OPERATING ROOM SERVICES LEVEL 4 PER MIN,Px00036010218,CDM,,,360,RC,,,,BOTH,,,77,69.3,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.06,,,60.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,39.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.92,,,73.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.6,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.11,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.84,,,70.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.45,,,65.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,73.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,37.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.06,73.92,
HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM,Px00040210043,CDM,76882,CPT,402,RC,,,,BOTH,,,77,69.3,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.06,,,60.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,39.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,64.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.92,,,73.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.6,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.11,,,60.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.84,,,70.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,39.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.45,,,65.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.15,,,69.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.3,,,73.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.73,,,37.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.06,73.92,
HC MASK NASAL DISP M/L CONTOUR DELUXE,Sx98980561023,CDM,,,270,RC,,,,BOTH,,,77.34,69.61,73.47,,,69.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.33,,,60.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.61,,,64.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.61,,,39.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.61,,,64.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.9,,,39.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.61,,,69.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.25,,,74.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,60.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,60.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.15,,,71.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.9,,,39.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.74,,,65.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.47,,,69.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.61,,,73.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.9,,,37.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.33,74.25,
HC ASSAY OF SIROLIMUS,Px00030112093,CDM,80195,CPT,300,RC,,,,BOTH,,,77.43,69.69,73.56,,,69.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.4,,,60.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.69,,,64.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.69,,,39.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.69,,,64.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.94,,,39.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.69,,,69.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.33,,,74.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.91,,,60.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.32,,,60.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.24,,,71.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.94,,,39.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.82,,,65.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.56,,,69.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.69,,,73.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,37.94,,,37.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.4,74.33,
LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,Rx44567043624,CDM,J1956,HCPCS,636,RC,44567043624,NDC,,BOTH,100,ML,77.62,44.1,73.74,,,73.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.54,,,60.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.86,,,69.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.86,,,69.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.86,,,69.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.03,,,38.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.86,,,69.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.52,,,74.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.05,,,57.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.03,,,38.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.41,,,71.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.03,,,38.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.98,,,65.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,73.74,,,73.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.86,,,69.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.03,,,38.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.54,74.52,
HC Haemonetics 208 Aspiration / Anticoagulation Set USE WITH 11972,Sx00000208-00,CDM,,,270,RC,,,,BOTH,,,78,70.2,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.84,,,60.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.6,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.3,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.84,74.88,
HC ASSAY OF FREE THYROXINE #,Px00030100659,CDM,84439,CPT,300,RC,,,,BOTH,,,78,70.2,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.84,,,60.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.6,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.3,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.84,74.88,
HC FREE T4,Px00030014933,CDM,84439,CPT,300,RC,,,,BOTH,,,78,70.2,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.84,,,60.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.6,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.3,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.84,74.88,
HC CLOTTING INHIBITORS PROTEIN C ACTIVITY #,Px00030510089,CDM,85303,CPT,300,RC,,,,BOTH,,,78,70.2,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.84,,,60.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.6,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.3,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.22,,,38.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.84,74.88,
CALCIUM CHLORIDE INJ 10%,Rx00409163110,CDM,,,250,RC,00409-1631-10,NDC,,BOTH,1,EA,78.03,54.55,74.13,,,74.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.86,,,60.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.23,,,70.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.23,,,70.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.23,,,70.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.23,,,38.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.23,,,70.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.91,,,74.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.35,,,57.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.62,,,38.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.79,,,71.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.23,,,38.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.33,,,66.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.13,,,74.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.23,,,70.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.23,,,38.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.86,74.91,
HC TUBE T DEAVER 16FR X-RAY OPAQUE RUBBER,Sx00000099830,CDM,,,270,RC,,,,BOTH,,,78.12,70.31,74.21,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.93,,,60.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,65.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,39.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,65.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,39.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75,,,75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.42,,,60.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.66,,,60.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.87,,,71.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,39.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.4,,,66.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.21,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,74.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,38.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.93,75,
HC TUBE T DEAVER 14FR X-RAY OPAQUE (DISCONTINUED W/NO SUBS),Sx00000099820,CDM,,,270,RC,,,,BOTH,,,78.12,70.31,74.21,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.93,,,60.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,65.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,39.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,65.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,39.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75,,,75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.42,,,60.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.66,,,60.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.87,,,71.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,39.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.4,,,66.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.21,,,70.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.31,,,74.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.28,,,38.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.93,75,
HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM,Px00098110523,CDM,20550,CPT,981,RC,,,,OUTPATIENT,,,168,151.2,94.08,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.35,,,131.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,177.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,177.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.46,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.4,,,56.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.79,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,37.79,,,131.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.76,,,154.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.92,,,85.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.76,,,142.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.15,,,159.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,37.79,,,37.79,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,37.79,75.15,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML,Rx00075801310,CDM,J1650,HCPCS,636,RC,75801310,NDC,,BOTH,0.3,ML,78.5,70.65,74.58,,,74.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.23,,,61.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.47,,,38.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.36,,,75.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,57.7,,,57.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,38.47,,,38.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.22,,,72.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.47,,,38.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.73,,,66.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.58,,,74.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,,,70.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,38.47,,,38.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.23,75.36,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML,Rx00075801301,CDM,J1650,HCPCS,636,RC,75801301,NDC,,BOTH,0.3,ML,78.5,70.65,74.58,,,70.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.23,,,61.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,65.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,40.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,65.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.47,,,40.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,70.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.36,,,75.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.7,,,61.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.47,,,61.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.22,,,72.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.47,,,40.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.73,,,66.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.58,,,70.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,74.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.47,,,38.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.23,75.36,
DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML,Rx25021046001,CDM,J2597,HCPCS,636,RC,25021046001,NDC,,BOTH,1,ML,78.88,44.1,74.94,,,71.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.53,,,61.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,65.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,40.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,65.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.65,,,40.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,71.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.72,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.98,,,61.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,38.65,,,61.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.57,,,72.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.65,,,40.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.05,,,67.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.94,,,71.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.99,,,74.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.65,,,38.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.53,75.72,
HC ASSAY OF ZINC #,Px00030100772,CDM,84630,CPT,300,RC,,,,BOTH,,,79,71.1,75.05,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.62,,,61.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,40.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.84,,,75.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.07,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.68,,,72.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.15,,,67.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.05,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,75.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,38.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.62,75.84,
HC IONTOPHORESIS PER 15-MIN,Px00042010125,CDM,97033,CPT,420,RC,,,,BOTH,,,79,71.1,75.05,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.62,,,61.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,40.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,65.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.84,,,75.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.07,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.1,,,61.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.68,,,72.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,40.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.15,,,67.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.05,,,71.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.1,,,75.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.71,,,38.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.62,75.84,
HC NEEDLE NERVE BLOCK 20GA X 4 IN SINGLE SHOT ECHOGENIC,Sx00000333648,CDM,,,272,RC,,,,BOTH,,,79.19,83.7,75.23,,,71.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.77,,,61.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,65.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,40.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,65.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.8,,,40.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,71.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.02,,,76.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.2,,,61.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.19,,,61.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.85,,,72.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.8,,,40.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,67.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.23,,,71.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,75.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.8,,,38.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.77,76.02,
HC PR ED 36680 INSERT NEEDLE BONE CAVITY CDM,Px00098110226,CDM,36680,CPT,981,RC,,,,OUTPATIENT,,,237,213.3,132.72,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.46,,,184.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,197.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,197.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.46,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.59,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.35,,,227.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,184.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,184.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.09,,,218.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.74,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.09,,,201.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.72,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.05,,,225.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,14.31,,,14.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,14.31,76.05,
NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W,Rx00338104902,CDM,,,250,RC,00338-1049-02,NDC,,BOTH,1,ML,79.31,69.86,75.34,,,71.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,61.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.38,,,66.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.38,,,40.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.38,,,66.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.86,,,40.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.38,,,71.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.14,,,76.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,61.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.25,,,61.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.97,,,72.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.86,,,40.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.41,,,67.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.34,,,71.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.38,,,75.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,38.86,,,38.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.86,76.14,
HC COMPREHEN METABOLIC PANEL,Px00030112062,CDM,80053,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC ANTI-CENTROMERE ANTIBODY,Px00030112483,CDM,83516,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP,Px00030113288,CDM,83516,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP,Px00030113289,CDM,83516,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC F-ACTIN (SMOOTH MUSCLE) AB IGG,Px00030210102,CDM,83516,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC ASSAY OF INSULIN TOTAL #,Px00030100622,CDM,83525,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC INSULIN LEVEL ASSAY,Px00030015267,CDM,83525,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,Px00030100665,CDM,84480,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC T3 ICMA,Px00030015997,CDM,84480,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CULTURE BACTERIA OTHER,Px00030610321,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,Px00030600080,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600362,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600363,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600364,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600365,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600366,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,Px00030600447,CDM,87070,CPT,300,RC,,,,BOTH,,,80,72,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,62.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,40.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,66.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.59,,,62.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.6,,,73.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,40.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68,,,68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76,,,72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.2,,,39.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.4,76.8,
CEFOXITIN SODIUM FOR IV SOLN 2 GM,Rx63323034241,CDM,J0694,HCPCS,636,RC,63323034241,NDC,,BOTH,2,GR,80.04,72.04,76.04,,,76.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.43,,,62.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.04,,,72.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.04,,,72.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.04,,,72.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.22,,,39.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.04,,,72.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.84,,,76.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,58.83,,,58.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,39.22,,,39.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.64,,,73.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.22,,,39.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.03,,,68.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.04,,,76.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.04,,,72.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,39.22,,,39.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.43,76.84,
CEFOXITIN SODIUM FOR IV SOLN 2 GM,Rx63323034229,CDM,J0694,HCPCS,636,RC,63323034229,NDC,,BOTH,2,GR,80.04,72.04,76.04,,,72.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.43,,,62.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,66.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,40.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,66.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,40.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,72.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.84,,,76.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.83,,,62.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,62.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.64,,,73.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,40.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.03,,,68.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.04,,,72.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,76.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.22,,,39.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.43,76.84,
HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O ULTRASOUND GUIDANCE,Px00097510382,CDM,20610,CPT,975,RC,,,,BOTH,,,151,135.9,84.56,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.01,,,117.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,165.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,165.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.5,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.95,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.05,,,62.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,117.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,117.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.07,,,138.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.23,,,76.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.07,,,128.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.56,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.96,,,143.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,43.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,43.91,76.96,
HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM,Px00098110530,CDM,20610,CPT,981,RC,,,,OUTPATIENT,,,151,135.9,84.56,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.01,,,117.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,165.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,165.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.5,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.95,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.05,,,62.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,117.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,117.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.07,,,138.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.23,,,76.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.07,,,128.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.56,,,135.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.96,,,143.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,43.91,,,43.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,43.91,76.96,
HC PACKING STAXI-STAT NASAL EPISTAXIS PACK 1.5x2.5x10cm,Sx0000Q602310,CDM,,,270,RC,,,,BOTH,,,80.61,72.55,76.58,,,72.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.88,,,62.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.55,,,67.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.55,,,41.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.55,,,67.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.5,,,41.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.55,,,72.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.39,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.25,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.89,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.16,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.5,,,41.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.52,,,68.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.58,,,72.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.55,,,76.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.5,,,39.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.88,77.39,
HC LIPOPROTEIN A,Px00030015399,CDM,83695,CPT,300,RC,,,,BOTH,,,80.72,72.65,76.68,,,72.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.96,,,62.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.65,,,67.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.65,,,41.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.65,,,67.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.55,,,41.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.65,,,72.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,77.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.33,,,62.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.95,,,62.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.26,,,74.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.55,,,41.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.61,,,68.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.68,,,72.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.65,,,76.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.55,,,39.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.96,77.49,
HC POLYMEM MAX 8 X 8 DRESSING NON ADHESIVE HCPCS A6211,Sx00000005088,CDM,,,270,RC,,,,BOTH,,,81.3,77.08,77.24,,,73.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.41,,,63.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.17,,,67.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.17,,,41.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.17,,,67.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.84,,,41.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.17,,,73.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.05,,,78.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.76,,,63.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.24,,,63.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.8,,,74.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.84,,,41.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.11,,,69.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.24,,,73.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.17,,,77.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.84,,,39.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.41,78.05,
HC RUBEOLA ANTIBODY - IGG,Px00030211133,CDM,86765,CPT,300,RC,,,,BOTH,,,81.32,73.19,77.25,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.43,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.07,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.77,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.25,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.81,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.25,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,39.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.43,78.07,
HC VARICELLA-ZOSTER ANTIBODY - IGG,Px00030011003,CDM,86787,CPT,300,RC,,,,BOTH,,,81.32,73.19,77.25,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.43,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.07,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.77,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.25,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.81,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.12,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.25,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.85,,,39.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.43,78.07,
HC PR 01990 SUPPORT FOR ORGAN DONOR,Px00096310202,CDM,1990,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2.69,,,2.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00756 ANESTH REPAIR OF HERNIA UPPER ABD; TRANSABD OF DIAPH,Px00096310062,CDM,756,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.96,,,31.96,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00534 ANESTH CARDIOVERTER/DEFIB,Px00096310046,CDM,534,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 01961 ANESTH CS DELIVERY,Px00096310195,CDM,1961,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00904 ANESTH PERINEAL SURGERY,Px00096310090,CDM,904,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 01486 ANESTH ANKLE REPLACEMENT,Px00096310150,CDM,1486,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 01922 ANESTH CAT OR MRI SCAN,Px00096310190,CDM,1922,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00632 ANESTH LUMBAR REGION,Px00096310251,CDM,632,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00790 ANESTH SURG UPPER ABDOMEN,Px00096310064,CDM,790,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 01402 ANESTH TOTAL KNEE ARTHROPLASTY,Px00096310135,CDM,1402,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,120.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,126.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC PR 00754 ANESTH REPAIR UPPER ABD; OMPHALOCELE,Px00096310061,CDM,754,CPT,963,RC,,,,BOTH,,,120.4,108.36,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.81,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.25,,,104.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,121.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.02,,,98.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,98.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,116.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.19,,,64.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.63,,,107.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.42,,,113.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,119.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.59,78.26,BASE FEE
HC ALPHA-1-ANTITRYPSIN PHENO,Px00030013041,CDM,82104,CPT,300,RC,,,,BOTH,,,81.55,73.4,77.47,,,73.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.61,,,63.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.4,,,67.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.4,,,41.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.4,,,67.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.96,,,41.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.4,,,73.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.29,,,78.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.94,,,63.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.36,,,63.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.03,,,75.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.96,,,41.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.32,,,69.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.47,,,73.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.4,,,77.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,39.96,,,39.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.61,78.29,
HC OPERATING ROOM SERVICES LEVEL 5 PER MIN,Px00036010220,CDM,,,360,RC,,,,BOTH,,,82,73.8,77.9,,,73.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.96,,,63.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.8,,,68.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.8,,,41.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.8,,,68.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.18,,,41.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.8,,,73.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.72,,,78.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.27,,,63.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.58,,,63.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.44,,,75.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.18,,,41.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.7,,,69.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.9,,,73.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.8,,,77.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.18,,,40.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.96,78.72,
HC PR 29581 MULTILAYER WND COMPRESSION BILATERAL,Px00098210305,CDM,29581,CPT,983,RC,,,,BOTH,,,29,26.1,16.24,,,26.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.19,,,22.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,27.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,18.13,,,27.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.74,,,29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.22,,,26.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,15.95,,,27.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,22.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,22.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.53,,,26.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.64,,,29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.53,,,24.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,16.24,,,26.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,27.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,25.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.86,78.75,
HC PR ED 29581 APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT CDM,Px00098110697,CDM,29581,CPT,981,RC,,,,OUTPATIENT,,,63,56.7,35.28,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.19,,,49.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,51.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,51.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.74,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.22,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.65,,,60.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,49.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,49.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.91,,,57.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.64,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.91,,,53.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,59.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,25.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.86,78.75,
HC PR 29581 MULTILAYER WND COMPRESSION,Px00098310855,CDM,29581,CPT,983,RC,,,,BOTH,,,63,56.7,35.28,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.19,,,49.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,51.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.38,,,51.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,29.74,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,33.22,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.65,,,60.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,49.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,49.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.91,,,57.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,26.64,,,30.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.91,,,53.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.28,,,56.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,59.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,25.86,,,25.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,25.86,78.75,
HC MUMPS ANTIBODY - IGG,Px00030210744,CDM,86735,CPT,300,RC,,,,BOTH,,,82.3,74.07,78.19,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,70.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.07,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.07,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.07,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.33,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.07,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.01,,,87.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.49,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.73,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.72,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.33,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.96,,,77.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.19,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.07,,,86.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.33,,,40.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.19,79.01,
HC ANGIOTENSIN I ENZYME TEST,Px00030112095,CDM,82164,CPT,300,RC,,,,BOTH,,,82.34,74.11,78.22,,,74.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.23,,,64.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.11,,,68.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.11,,,41.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.11,,,68.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.35,,,41.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.11,,,74.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.05,,,79.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.52,,,64.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.75,,,64.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.75,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.35,,,41.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.99,,,69.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,74.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.11,,,78.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.35,,,40.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.23,79.05,
HC ASSAY TRANSFERRIN,Px00030014358,CDM,84466,CPT,300,RC,,,,BOTH,,,82.99,74.69,78.84,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.73,,,73.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,47.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.67,,,90.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.07,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.35,,,86.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.54,,,79.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.84,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,89.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,40.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.73,79.67,
HC CRYPTOSPORIDIUM AG EIA,Px00030011355,CDM,87328,CPT,300,RC,,,,BOTH,,,83,74.7,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.74,,,64.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,79.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.01,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.08,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.36,,,76.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.55,,,70.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,78.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,40.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.74,79.68,
HC GIARDIA ANTIGEN,Px00030610583,CDM,87329,CPT,300,RC,,,,BOTH,,,83,74.7,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.74,,,64.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,79.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.01,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.08,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.36,,,76.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.55,,,70.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,78.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,40.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.74,79.68,
HC IAAD IA SHIGA-LIKE TOXIN #,Px00030610752,CDM,87427,CPT,300,RC,,,,BOTH,,,83,74.7,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.74,,,64.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,79.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.01,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.08,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.36,,,76.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.55,,,70.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,78.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,40.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.74,79.68,
HC XR CHEST 1 VIEW,Px00032410014,CDM,71045,CPT,320,RC,,,,BOTH,,,83,74.7,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.74,,,64.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,42.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,69.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,79.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.01,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.08,,,64.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.36,,,76.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,42.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.55,,,70.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,74.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,78.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,40.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.74,79.68,
HC XR CHEST PORTABLE 1 VIEW,Px00032410018,CDM,71045,CPT,320,RC,,,,BOTH,,,158,74.7,78.85,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.74,,,123.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,131.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,80.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,131.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,80.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.01,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.08,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.36,,,145.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,80.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.55,,,134.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.7,,,150.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.67,,,77.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,64.74,79.68,
HC CURETTE 9MM UTERINE SUCTION LONG CURVED/ TIS-U-TRAP#449,Sx000000MX449,CDM,,,270,RC,,,,BOTH,,,83.43,75.09,79.26,,,75.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.08,,,65.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,69.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,42.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,69.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.88,,,42.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,75.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.09,,,80.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.32,,,65.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.29,,,65.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.76,,,76.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.88,,,42.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.92,,,70.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.26,,,75.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,79.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,40.88,,,40.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.08,80.09,
"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",Rx17478071130,CDM,,,250,RC,17478-0711-30,NDC,,BOTH,1,EA,83.7,75.33,79.52,,,79.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.29,,,65.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.35,,,80.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.52,,,61.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.42,,,41.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77,,,77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.15,,,71.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.52,,,79.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.29,80.35,
"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",Rx17478071130,CDM,,,250,RC,17478-0711-30,NDC,,BOTH,1,EA,83.7,130.91,79.52,,,79.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.29,,,65.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.35,,,80.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.52,,,61.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,41.42,,,41.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77,,,77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.15,,,71.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.52,,,79.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.33,,,75.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,41.01,,,41.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.29,80.35,
HC SURGISEAL TOPICAL SKIN,Sx00000SS035T,CDM,,,270,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC ANTINUCLEAR ANTIBODIES - ANA,Px00030210369,CDM,86038,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC ANTINUCLEAR ANTIBODIES ANA #,Px00030210913,CDM,86038,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC ANTINUCLEAR ANTIBODIES ANA #,Px00030210916,CDM,86038,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC ANTINUCLEAR ANTIBODIES ANA #,Px00030200502,CDM,86038,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC COMPLEMENT ANTIGEN,Px00030210459,CDM,86160,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC COMPLEMENT ANTIGEN EACH COMPONENT #,Px00030200124,CDM,86160,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC COMPLEMENT ANTIGEN EACH COMPONENT #,Px00030200125,CDM,86160,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC COMPLEMENT ANTIGEN EACH COMPONENT #,Px00030200136,CDM,86160,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,Px00030210186,CDM,86256,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC HEP B CORE ANTIBODY TOTAL,Px00030210943,CDM,86704,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL #,Px00030200553,CDM,86704,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL #,Px00030200554,CDM,86704,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL #,Px00030200684,CDM,86704,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL #,Px00030200685,CDM,86704,CPT,300,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC OPERATING ROOM SERVICES LEVEL 6 PER MIN,Px00036010222,CDM,,,360,RC,,,,BOTH,,,84,75.6,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.52,,,65.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,42.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,69.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,41.57,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,77.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,42.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.4,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,75.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.6,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.16,,,41.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,65.52,80.64,
HC PR ED 20553 INJECT TRIGGER POINTS =/> 3 CDM,Px00098110526,CDM,20553,CPT,981,RC,,,,OUTPATIENT,,,146,131.4,81.76,,,131.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.63,,,113.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.25,,,161.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.25,,,161.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.35,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.37,,,131.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.3,,,58.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.3,,,113.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.3,,,113.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.22,,,134.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.51,,,74.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.22,,,124.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.76,,,131.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.46,,,138.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.3,,,40.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.3,81.46,
HC PREGNANCY ASSOCIATED PLASMA PROTEIN A (PAPP A),Px00030112528,CDM,84163,CPT,300,RC,,,,BOTH,,,84.88,76.39,80.64,,,76.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.21,,,66.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.39,,,70.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.39,,,43.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.39,,,70.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.59,,,43.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.39,,,76.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.48,,,81.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.39,,,66.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.01,,,66.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.09,,,78.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.59,,,43.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.15,,,72.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.64,,,76.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.39,,,80.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.59,,,41.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.21,81.48,
HC GARMENT CALF VASOPRESS LARGE,Px00013111WNH,CDM,,,270,RC,,,,BOTH,,,84.9,76.41,80.66,,,76.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.22,,,66.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.41,,,70.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.41,,,43.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.41,,,70.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.6,,,43.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.41,,,76.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.5,,,81.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.4,,,66.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.02,,,66.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.11,,,78.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.6,,,43.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.17,,,72.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.66,,,76.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.41,,,80.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.6,,,41.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.22,81.5,
HC AB ASPERGILLUS (RL),Px00031900105,CDM,86606,CPT,300,RC,,,,BOTH,,,85,76.5,80.75,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.3,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,70.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,43.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,70.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,43.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.48,,,66.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.07,,,66.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,43.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.25,,,72.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.65,,,41.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.3,81.6,
HC SPLINT KNEE 20 IN XXLG SUPER 22 IN-24,Sx00079-80029,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,85.02,76.52,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,66.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,43.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.62,,,81.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.49,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,78.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.32,81.62,
HC SPLINT KNEE 20 IN SMALL SUPER 14 IN-16,Sx00000080023,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,85.02,76.52,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,66.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,43.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.62,,,81.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.49,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,78.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.32,81.62,
HC SPLINT KNEE 20 IN MED SUPER 16 IN-18,Sx00000080025,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,85.02,76.52,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,66.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,43.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.62,,,81.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.49,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,78.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.32,81.62,
HC SPLINT KNEE 20 IN LARGE SUPER 18 IN-20,Sx00000080027,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,85.02,76.52,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,66.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,43.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.62,,,81.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.49,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,78.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.32,81.62,
HC SPLINT KNEE 20 IN XLARGE SUPER 20 IN-22,Sx00000080028,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,85.02,76.52,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,66.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,43.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,70.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.62,,,81.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.49,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,66.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.22,,,78.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,43.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.27,,,72.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.77,,,76.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.52,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.66,,,41.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.32,81.62,
HC CMV ANTIBODY,Px00030010753,CDM,86644,CPT,300,RC,,,,BOTH,,,85.58,73.04,81.3,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.75,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.02,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.02,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.02,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.93,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.02,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.16,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.9,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.35,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.73,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.93,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.74,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.3,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.02,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,41.93,,,41.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.75,82.16,
HC ECHOBRIGHT 20GA X 100MM BLOCK NEEDLE W INJECTION SET,Sx0EBL20100SG,CDM,,,270,RC,,,,BOTH,,,85.72,77.15,81.43,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.86,,,60.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,39.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,64.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.29,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.42,,,60.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.86,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42,,,39.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.86,,,66.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.43,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42,,,42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,66.86,82.29,
"HC SPLINT KNEE 20"" LARGE",Px00000269WNH,CDM,L1830,CPT,274,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
"HC SPLINT KNEE 20"" MEDIUM",Px00000268WNH,CDM,L1830,CPT,274,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC KNEE IMMOBILIZER,Px00032110WNH,CDM,L1830,CPT,274,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC COPPER.,Px00030014603,CDM,82525,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC CLOTTING INHIBITORS PROTEIN S FREE #,Px00030510230,CDM,85306,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY,Px00030510156,CDM,85307,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC HEP A ANTIBODY TOTAL,Px00030210737,CDM,86708,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC HEPATITIS A ANTIBODY HAAB #,Px00030200126,CDM,86708,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC HEPATITIS A ANTIBODY HAAB #,Px00030200127,CDM,86708,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC HEPATITIS A ANTIBODY HAAB #,Px00030200687,CDM,86708,CPT,300,RC,,,,BOTH,,,86,77.4,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,67.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,43.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,71.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.56,,,82.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.56,,,67.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,43.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.1,,,73.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,77.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.4,,,81.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.14,,,42.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.08,82.56,
HC PREFAB CANVAS KO IMMOBILIZER,Px00000216WNH,CDM,L1830,CPT,274,RC,,,,BOTH,,,86.1,77.49,81.8,,,77.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.16,,,67.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,71.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,43.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,71.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,43.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,77.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.66,,,82.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.28,,,67.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,67.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.21,,,79.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,43.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,73.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.8,,,77.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,81.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.19,,,42.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.16,82.66,
HC HYDROFERA TRANSFER BLUE 8 X 8,Px00013710WNH,CDM,,,270,RC,,,,BOTH,,,86.16,77.54,81.85,,,77.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.2,,,67.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,71.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,43.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,71.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.22,,,43.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,77.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.71,,,82.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.33,,,67.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.64,,,67.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,79.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.22,,,43.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.24,,,73.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.85,,,77.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,81.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.22,,,42.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.2,82.71,
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN,Px00030010814,CDM,86664,CPT,300,RC,,,,BOTH,,,86.24,77.62,81.93,,,77.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.27,,,67.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,71.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,43.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,71.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.26,,,43.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,77.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.79,,,82.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.39,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.68,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.26,,,43.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.3,,,73.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.93,,,77.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,81.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.26,,,42.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.27,82.79,
HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM,Px00098110469,CDM,29125,CPT,981,RC,,,,OUTPATIENT,,,154,138.6,86.24,,,138.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.9,,,120.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.25,,,167.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.25,,,167.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.26,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.35,,,138.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.7,,,53.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,120.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,120.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.78,,,141.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.44,,,78.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.78,,,130.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,138.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,146.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.23,,,40.23,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.23,82.8,
CASTELLANI PAINT,Rx54633061201,CDM,,,250,RC,54633-0612-01,NDC,,BOTH,1,EA,86.38,77.74,82.06,,,77.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.38,,,67.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,71.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,44.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,71.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.33,,,44.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,77.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.92,,,82.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.49,,,67.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.75,,,67.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.47,,,79.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.33,,,44.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.42,,,73.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.06,,,77.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,82.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.33,,,42.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.38,82.92,
FLUOROMETHOLONE OPHTH SUSP 0.1%,Rx60758088005,CDM,,,250,RC,60758-0880-05,NDC,,BOTH,1,EA,86.57,77.99,82.24,,,79.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.52,,,68.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,73.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,44.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,73.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.42,,,44.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.11,,,84.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.63,,,68.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.84,,,68.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.64,,,80.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.42,,,44.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.58,,,74.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.24,,,79.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,83.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.42,,,42.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.52,83.11,
DAPTOMYCIN FOR IV SOLN 500 MG,Rx70594003401,CDM,J0878,HCPCS,636,RC,70594003401,NDC,,BOTH,500,ME,86.6,364.37,82.27,,,82.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,67.55,,,67.55,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.94,,,77.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.94,,,77.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.94,,,77.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.43,,,42.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.94,,,77.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,83.14,,,83.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,63.65,,,63.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,42.43,,,42.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.67,,,79.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.43,,,42.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.61,,,73.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,82.27,,,82.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.94,,,77.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,42.43,,,42.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.55,83.14,
HC ASSAY OF DIGOXIN,Px00030112109,CDM,80162,CPT,300,RC,,,,BOTH,,,86.95,78.26,82.6,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.82,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.47,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.91,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.03,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.99,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.91,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.6,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.26,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.61,,,42.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.82,83.47,
"HC STIMULATING NERVE BLOCK NEEDLE W/ FACET S TIP 22G X 2""",Sx00001287-74,CDM,,,272,RC,,,,BOTH,,,87,78.3,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.86,,,67.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,44.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.52,,,83.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.95,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.06,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.04,,,80.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.95,,,73.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,82.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,42.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.86,83.52,
HC CARBOXYHEMOGLOBIN QUANTITATIVE #,Px00030100576,CDM,82375,CPT,300,RC,,,,BOTH,,,87,78.3,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.86,,,67.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,44.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.52,,,83.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.95,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.06,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.04,,,80.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.95,,,73.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,82.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,42.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.86,83.52,
HC CARBOXYHEMOGLOBIN,Px00030112287,CDM,82375,CPT,300,RC,,,,BOTH,,,87,78.3,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.86,,,67.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,44.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.52,,,83.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.95,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.06,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.04,,,80.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.95,,,73.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,82.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,42.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.86,83.52,
HC TROPONIN QUANTITATIVE,Px00030016091,CDM,84484,CPT,300,RC,,,,BOTH,,,87,78.3,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.86,,,67.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,44.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,72.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.52,,,83.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.95,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.06,,,67.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.04,,,80.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,44.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.95,,,73.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,78.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,82.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,42.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.86,83.52,
HC ASSAY OF TROPONIN QUANTITATIVE #,Px00030100666,CDM,84484,CPT,300,RC,,,,BOTH,,,140,78.3,82.65,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.86,,,109.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,116.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,71.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,116.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,71.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.52,,,134.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.95,,,109.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.06,,,109.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.04,,,128.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,71.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.95,,,119,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.3,,,133,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.63,,,68.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,67.86,83.52,
HC SAW BLADE 5023-162 MICRO OS 5.5 X 18.5 X 0.4MM,Sx0005023-262,CDM,,,270,RC,,,,BOTH,,,87.3,78.57,82.94,,,78.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.09,,,68.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,72.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,44.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,72.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,44.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,78.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.81,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.17,,,68.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,68.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,44.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.21,,,74.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.94,,,78.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,82.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,42.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.09,83.81,
HC SAW BLADE 5023-160 MICRO OS 5.5 X 12 X 0.4MM,Sx0005023-260,CDM,,,270,RC,,,,BOTH,,,87.3,78.57,82.94,,,78.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.09,,,68.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,72.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,44.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,72.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,44.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,78.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.81,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.17,,,68.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.2,,,68.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,44.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.21,,,74.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.94,,,78.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.57,,,82.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,42.78,,,42.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.09,83.81,
HC CYSTATIN C,Px00030014653,CDM,82610,CPT,300,RC,,,,BOTH,,,88,79.2,83.6,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.64,,,68.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,73.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,44.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,73.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,44.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.48,,,84.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,68.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.55,,,68.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.96,,,80.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,44.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.8,,,74.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.6,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,83.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,43.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.64,84.48,
HC OPERATING ROOM SERVICES LEVEL 7 PER MIN,Px00036010224,CDM,,,360,RC,,,,BOTH,,,88,79.2,83.6,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.64,,,68.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,73.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,44.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,73.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,44.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.48,,,84.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,68.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,43.55,,,68.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.96,,,80.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,44.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.8,,,74.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.6,,,79.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.2,,,83.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.12,,,43.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.64,84.48,
HC PR ED 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM,Px00098110821,CDM,65222,CPT,981,RC,,,,OUTPATIENT,,,158,142.2,88.48,,,142.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.44,,,123.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.75,,,131.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.75,,,80.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.75,,,131.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.87,,,80.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.97,,,142.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.9,,,151.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.58,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.58,,,123.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.06,,,145.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.04,,,80.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.06,,,134.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.48,,,142.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,150.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.58,,,48.58,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,48.58,84.6,
CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML,Rx67457021810,CDM,J0735,HCPCS,636,RC,67457021810,NDC,,BOTH,1,ML,88.15,79.4,83.74,,,83.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,68.76,,,68.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.19,,,43.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.62,,,84.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,64.79,,,64.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.19,,,43.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.1,,,81.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.19,,,43.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.93,,,74.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,83.74,,,83.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.34,,,79.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.19,,,43.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,68.76,84.62,
METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML,Rx00703006301,CDM,J1040,HCPCS,636,RC,703006301,NDC,,BOTH,1,ML,88.47,79.69,84.05,,,84.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.01,,,69.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.62,,,79.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.62,,,79.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.62,,,79.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.35,,,43.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.62,,,79.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.93,,,84.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.03,,,65.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,43.35,,,43.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.39,,,81.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.35,,,43.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.2,,,75.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.05,,,84.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.62,,,79.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.35,,,43.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.01,84.93,
HC SPLINT THUMB SPICA,Px00032700WNH,CDM,L3807,CPT,274,RC,,,,BOTH,,,89,80.1,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.42,,,69.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,45.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.44,,,85.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.42,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.05,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.88,,,81.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.65,,,75.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,84.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,43.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.42,85.44,
HC DDIMER QUANT,Px00030014674,CDM,85379,CPT,300,RC,,,,BOTH,,,89,80.1,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.42,,,69.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,45.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.44,,,85.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.42,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.05,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.88,,,81.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.65,,,75.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,84.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,43.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.42,85.44,
HC PR 94660 CPAP VENTILATION CPAP INITIATION&MGMT,Px00097610039,CDM,94660,CPT,410,RC,,,,BOTH,,,89,80.1,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.42,,,69.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,45.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,74.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.44,,,85.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.42,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.05,,,69.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.88,,,81.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,45.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.65,,,75.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.55,,,80.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.1,,,84.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.61,,,43.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.42,85.44,
HC SPLINT THUMB 7.25 SMALL RIGHT,Px00011847WNH,CDM,L3807,CPT,274,RC,,,,BOTH,,,89.1,80.19,84.65,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.5,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.66,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.54,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.49,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.97,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.66,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.74,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.65,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.66,,,43.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.5,85.54,
CLINDAMYCIN PHOSPHATE VAGINAL CREAM 2%,Rx00168027740,CDM,,,250,RC,00168-0277-40,NDC,,BOTH,1,EA,89.2,66.98,84.74,,,67.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,58.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.28,,,62.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.28,,,38.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.28,,,62.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.71,,,38.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.28,,,67.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,72.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.56,,,58.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.15,,,58.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.06,,,69.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.71,,,38.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.82,,,63.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.74,,,67.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.28,,,71.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.71,,,43.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.58,85.63,
DEXAMETHASONE OPHTH SUSP 0.1%,Rx00998061505,CDM,,,250,RC,00998-0615-05,NDC,,BOTH,1,EA,89.24,80.32,84.78,,,84.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,69.61,,,69.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,85.67,,,85.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,65.59,,,65.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,44.16,,,44.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.1,,,82.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.85,,,75.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.78,,,84.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.32,,,80.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,43.73,,,43.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,69.61,85.67,
HC WHEELCHAIR FOAM PAD,Px00000920WNH,CDM,,,270,RC,,,,BOTH,,,89.76,80.78,85.27,,,80.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.01,,,70.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.78,,,74.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.78,,,45.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.78,,,74.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.98,,,45.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.78,,,80.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.17,,,86.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.97,,,70.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.42,,,70.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.58,,,82.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.98,,,45.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.3,,,76.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.27,,,80.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.78,,,85.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,43.98,,,43.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.01,86.17,
"HC QUIKCLOT CLOTTING GAUZE 3""X 24"" 2 STRIPS",Sx005020-0016,CDM,,,270,RC,,,,BOTH,,,89.97,67.47,85.47,,,80.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.18,,,70.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.97,,,74.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.97,,,45.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.97,,,74.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.09,,,45.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.97,,,80.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.37,,,86.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.13,,,70.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.53,,,70.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.77,,,82.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.09,,,45.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.47,,,76.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.47,,,80.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.97,,,85.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.09,,,44.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.18,86.37,
HC KIT OB VACUUM DELIVERY,Px00001422WNH,CDM,,,270,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC VACUUM CUP MANUAL DELIVERY VAC CUP & TUBE W/FLUID TRAP,Sx000000004CB,CDM,,,270,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC MESH 6X6 IN STYLE 6 LIGHT HERNIAMESH FLAT STYLE 6,Sx00000H61515,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC CRP HIGH SENSITIVITY,Px00030010421,CDM,86141,CPT,300,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY #,Px00030210249,CDM,86200,CPT,300,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC XR ABDOMEN 1 VIEW,Px00032010029,CDM,74018,CPT,320,RC,,,,BOTH,,,90,81,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.2,,,70.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,45.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,74.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.54,,,70.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,45.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.5,,,76.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.1,,,44.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.2,86.4,
HC RUBELLA ANTIBODY - IGG ANTIBODY,Px00030210769,CDM,86762,CPT,300,RC,,,,BOTH,,,90.58,81.52,86.05,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,50.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.96,,,96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.58,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,44.83,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.33,,,92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.99,,,85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.05,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.38,,,44.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.65,86.96,
HC EPSTEIN-BARR ANTIBODY EARLY ANTIGEN,Px00030010809,CDM,86663,CPT,300,RC,,,,BOTH,,,91,81.9,86.45,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.98,,,70.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.36,,,87.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.89,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.04,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.72,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.35,,,77.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.45,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,86.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,44.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.98,87.36,
HC ANTIBODY DETECTION NOS IF,Px00030011343,CDM,87299,CPT,300,RC,,,,BOTH,,,91,81.9,86.45,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.98,,,70.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,46.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,75.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.36,,,87.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.89,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.04,,,70.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.72,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,46.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.35,,,77.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.45,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,86.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.59,,,44.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.98,87.36,
HC CATH 14 FRENCH COUDE,Px00007342WNH,CDM,,,270,RC,,,,BOTH,,,91.2,82.08,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.14,,,71.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,46.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.03,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.13,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.9,,,83.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.52,,,77.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,86.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,44.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.14,87.55,
HC CATH 16 FRENCH COUDE,Px00007343WNH,CDM,,,270,RC,,,,BOTH,,,91.2,82.08,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.14,,,71.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,46.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.03,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.13,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.9,,,83.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.52,,,77.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,86.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,44.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.14,87.55,
HC CATH 18 FRENCH COUDE,Px00007344WNH,CDM,,,270,RC,,,,BOTH,,,91.2,82.08,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.14,,,71.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,46.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.03,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.13,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.9,,,83.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.52,,,77.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,86.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,44.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.14,87.55,
HC CATH 20 FRENCH COUDE,Px00007345WNH,CDM,,,270,RC,,,,BOTH,,,91.2,82.08,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.14,,,71.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,46.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,75.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.03,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.13,,,71.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.9,,,83.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,46.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.52,,,77.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.64,,,82.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,86.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.69,,,44.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.14,87.55,
HC ASSAY OF BETA-2 PROTEIN,Px00030112218,CDM,82232,CPT,300,RC,,,,BOTH,,,91.26,82.13,86.7,,,82.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.18,,,71.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,75.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,46.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,75.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,46.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,82.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.61,,,87.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,71.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.16,,,71.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.96,,,83.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,46.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.57,,,77.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.7,,,82.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,86.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,44.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.18,87.61,
HC DRESSING NEGATIVE PRESSURE V.A.C. WHITEFOAM NON-ADHERENT SMALL 7.5CM X 10CM 1CM THK,SxM6275033/10,CDM,,,270,RC,,,,BOTH,,,91.26,54,86.7,,,82.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.18,,,71.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,75.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,46.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,75.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,46.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,82.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.61,,,87.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,71.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.16,,,71.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.96,,,83.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,46.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.57,,,77.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.7,,,82.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.13,,,86.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.72,,,44.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.18,87.61,
HC MERCURY QUANT BLOOD,Px00030015440,CDM,83825,CPT,300,RC,,,,BOTH,,,91.71,82.54,87.12,,,82.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.53,,,71.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.54,,,76.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.54,,,46.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.54,,,76.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.94,,,46.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.54,,,82.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.04,,,88.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.41,,,71.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.39,,,71.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.37,,,84.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.94,,,46.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.95,,,77.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.12,,,82.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.54,,,87.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,44.94,,,44.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.53,88.04,
HC CIRCUIT VENTILATOR,Px00007062WNH,CDM,,,270,RC,,,,BOTH,,,91.86,82.67,87.27,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.65,,,71.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.67,,,76.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.67,,,46.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.67,,,76.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.01,,,46.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.67,,,82.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.19,,,88.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.52,,,71.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.46,,,71.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.51,,,84.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.01,,,46.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.08,,,78.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.27,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.67,,,87.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.01,,,45.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.65,88.19,
HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE #,Px00030110131,CDM,80175,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC DRUG SCRN QUAN LEVETIRACETAM,Px00030110132,CDM,80177,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC DRUG SCRN QUANT OXCARBAZEPIN #,Px00030110134,CDM,80183,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC ANTIBODY HERPES SMPLX TYPE 1 #,Px00030200551,CDM,86695,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC HERPES SIMPLEX 1 TEST,Px00030010889,CDM,86695,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC ANTIBODY TREPONEMA PALLIDUM #,Px00030200558,CDM,86780,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC ANTIBODY TREPONEMA PALLIDUM #,Px00030200559,CDM,86780,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC ANTIBODY TREPONEMA PALLIDUM #,Px00030200560,CDM,86780,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC TREPONEMA PALLIDUM,Px00030010996,CDM,86780,CPT,300,RC,,,,BOTH,,,92,82.8,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,71.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,46.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,76.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.53,,,71.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.64,,,84.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,46.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,82.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.08,,,45.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.76,88.32,
HC HYDROFERA BLUE READY 8X8,Sx000HBRS8820,CDM,,,270,RC,,,,BOTH,,,92.35,83.12,87.73,,,83.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.03,,,72.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,76.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,47.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,76.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,47.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,83.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.66,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.88,,,72.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.7,,,72.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.96,,,84.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,47.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.5,,,78.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.73,,,83.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,87.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,45.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.03,88.66,
HC HYDROFERA BLUE TRANSFER 8X8,Sx000HBRT8080,CDM,,,270,RC,,,,BOTH,,,92.35,83.12,87.73,,,83.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.03,,,72.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,76.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,47.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,76.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,47.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,83.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.66,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.88,,,72.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.7,,,72.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.96,,,84.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,47.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.5,,,78.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.73,,,83.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.12,,,87.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.25,,,45.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.03,88.66,
HC MEDIHONEY DRESSSING HYDROGEL,Px00012216WNH,CDM,,,270,RC,,,,BOTH,,,92.4,83.16,87.78,,,83.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.07,,,72.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.16,,,76.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.16,,,47.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.16,,,76.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.28,,,47.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.16,,,83.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.7,,,88.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.91,,,72.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,45.73,,,72.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.01,,,85.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.28,,,47.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.54,,,78.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.78,,,83.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.16,,,87.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.28,,,45.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.07,88.7,
HC WALKER EQUALIZER SMALL,Px00002547WNH,CDM,,,270,RC,,,,BOTH,,,93,83.7,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.54,,,72.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.28,,,89.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.36,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.03,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.56,,,85.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.05,,,79.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,45.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.54,89.28,
HC TRANSDUCER PRESSURE IV DPT DISP SET,Sx000000PX272,CDM,,,270,RC,,,,BOTH,,,93,63.18,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.54,,,72.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.28,,,89.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.36,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.03,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.56,,,85.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.05,,,79.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,45.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.54,89.28,
HC SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM #,Px00030000012,CDM,89321,CPT,300,RC,,,,BOTH,,,93,83.7,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.54,,,72.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.28,,,89.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.36,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.03,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.56,,,85.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.05,,,79.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,45.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.54,89.28,
HC SEMEN ANALYSIS  SPERM DETECTION AND MOTILITY,Px00030011752,CDM,89321,CPT,300,RC,,,,BOTH,,,93,83.7,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.54,,,72.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,47.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,77.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.28,,,89.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.36,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.03,,,72.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.56,,,85.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,47.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.05,,,79.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.35,,,83.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.7,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.57,,,45.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.54,89.28,
HC PR 01962 ANESTH EMER HYSTERECTOMY,Px00096310196,CDM,1962,CPT,963,RC,,,,BOTH,,,137.6,123.84,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.68,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.3,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.36,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.44,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.67,89.44,BASE FEE
HC PR 01214 ANESTH HIP ARTHROPLASTY,Px00096310116,CDM,1214,CPT,963,RC,,,,BOTH,,,137.6,123.84,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.68,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.3,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.36,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.44,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.67,89.44,BASE FEE
HC PR 00851 ANESTH TUBAL LIGATION,Px00096310079,CDM,846,CPT,963,RC,,,,BOTH,,,137.6,123.84,77.06,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,104.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,108.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.68,,,104.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.3,,,84.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,84.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,100.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.36,,,55.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,92.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.06,,,98.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.44,,,103.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.67,89.44,BASE FEE
HC PR 01963 ANESTH CS HYSTERECTOMY,Px00096310197,CDM,1963,CPT,963,RC,,,,BOTH,,,137.6,123.84,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,119.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.68,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.3,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.36,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.44,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.67,89.44,BASE FEE
HC PR 00846 ANESTH HYSTERECTOMY,Px00096310077,CDM,846,CPT,963,RC,,,,BOTH,,,137.6,123.84,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.93,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86,,,136.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,143.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.68,,,137.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.3,,,111.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.67,,,111.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,131.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.36,,,73.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.43,,,121.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.06,,,129,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.44,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.59,,,56.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.67,89.44,BASE FEE
"HC PR 51702 INSERT,TEMP INDWELLING BLAD CATH,SIMPLE",Px00097510653,CDM,51702,CPT,975,RC,,,,BOTH,,,157,141.3,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,31.77,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,169.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,169.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.58,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.99,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.35,,,150.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.98,,,122.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.98,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,144.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.7,,,28.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,133.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.55,,,149.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.98,,,23.98,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.98,89.55,
HC HYRDROFERA DRESSING BLUE 8 X 8,Px00013709WNH,CDM,,,270,RC,,,,BOTH,,,93.6,84.24,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.8,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.32,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,86.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,45.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.01,89.86,
HC SPLINT THUMB LEFT - LARGE,Px00009309WNH,CDM,,,270,RC,,,,BOTH,,,93.6,84.24,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.8,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.32,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,86.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,45.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.01,89.86,
HC SPLINT THUMB RIGHT - LARGE,Px00009310WNH,CDM,,,270,RC,,,,BOTH,,,93.6,84.24,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.8,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.32,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,86.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,45.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.01,89.86,
HC CATH 20FR 16 IN COUDE SILICONE TIEMANN FOLEY 2WAY 5M,Sx00171305200,CDM,,,270,RC,,,,BOTH,,,93.6,84.24,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.8,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.32,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,86.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,45.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.01,89.86,
HC PREFAB WHFO WO JNTS,Px00005691WNH,CDM,L3807,CPT,274,RC,,,,BOTH,,,93.6,84.24,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,47.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,77.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.8,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.32,,,73.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,86.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,47.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,45.86,,,45.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.01,89.86,
FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),Rx67457051600,CDM,Q2009,HCPCS,636,RC,67457051600,NDC,,BOTH,2,ML,93.85,84.47,89.16,,,89.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,73.2,,,73.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.47,,,84.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.47,,,84.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.47,,,84.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.99,,,45.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.47,,,84.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,90.1,,,90.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,68.98,,,68.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,45.99,,,45.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.34,,,86.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.99,,,45.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.77,,,79.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.16,,,89.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,84.47,,,84.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,45.99,,,45.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.2,90.1,
HC ASSAY DIPROPYLACETIC ACID,Px00030112174,CDM,80164,CPT,300,RC,,,,BOTH,,,94,84.6,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.32,,,73.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,47.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.24,,,90.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.52,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.48,,,86.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.9,,,79.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,89.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,46.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.32,90.24,
HC ALPHA1-ANTITRYPSIN,Px00030014151,CDM,82103,CPT,300,RC,,,,BOTH,,,94,84.6,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.32,,,73.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,47.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.24,,,90.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.52,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.48,,,86.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.9,,,79.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,89.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,46.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.32,90.24,
HC XR SHOULDER 1 VIEW,Px00032010092,CDM,73020,CPT,320,RC,,,,BOTH,,,94,84.6,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.32,,,73.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,47.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.24,,,90.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.52,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.48,,,86.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.9,,,79.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.3,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.6,,,89.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.06,,,46.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.32,90.24,
HC IMMUNOASSAY INFECTIOUS AGENT - HEPATITIS,Px00030210564,CDM,86317,CPT,300,RC,,,,BOTH,,,94.27,84.84,89.56,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.53,,,81.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.84,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.84,,,53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.84,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.19,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.84,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.5,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.29,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.65,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,95.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.19,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.13,,,88.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.56,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.84,,,98.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.19,,,46.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.53,90.5,
HC SPLINT THUMB LARGE LEFT,Sx00000003070,CDM,,,270,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC SPLINT THUMB LARGE RIGHT,Sx00000003170,CDM,,,270,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC SPLINT THUMB 7.25 SMALL LEFT SPICA,Sx00000003030,CDM,L3807,HCPCS,274,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC SPLINT THUMB 7.25 SMALL RIGHT SPICA,Sx00000003130,CDM,L3807,HCPCS,274,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC SPLINT THUMB 8 IN MED RT SPICA,Sx00000003150,CDM,L3807,HCPCS,274,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC SPLINT THUMB 8 IN MED LT SPICA,Sx00000003050,CDM,L3807,HCPCS,274,RC,,,,BOTH,,,94.44,80.19,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.66,,,69.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,45.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,74.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,80.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,85.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.41,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.74,,,69.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.88,,,81.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,45.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.27,,,75.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,80.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85,,,84.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.28,,,46.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.66,90.66,
HC GUIDE WIRE 0.062 in W/TROCAR TIP,Sx000AR-8750K,CDM,,,270,RC,,,,BOTH,,,94.5,85.05,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.71,,,73.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,48.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,85.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,90.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.46,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.77,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.94,,,86.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.33,,,80.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,89.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.71,90.72,
HC GUIDE WIRE 2.4mm W/TROCAR TIP,Sx000AR-8770K,CDM,,,270,RC,,,,BOTH,,,94.5,85.05,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.71,,,73.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,48.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,85.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,90.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.46,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.77,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.94,,,86.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.33,,,80.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,89.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.71,90.72,
"HC GUIDE WIRE .094"" x 8"" W/TROCAR TIP",Sx000AR-8967K,CDM,,,270,RC,,,,BOTH,,,94.5,85.05,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.71,,,73.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,48.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,85.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,90.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.46,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.77,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.94,,,86.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.33,,,80.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,89.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.71,90.72,
HC GUIDE WIRE .062 W/TROCAR TIP,Sx000AR-8941K,CDM,,,270,RC,,,,BOTH,,,94.5,85.05,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.71,,,73.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,48.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,78.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,85.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,90.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.46,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.77,,,73.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.94,,,86.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,48.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.33,,,80.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.78,,,85.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.05,,,89.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.31,,,46.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.71,90.72,
HC CALCIUM IONIZED,Px00030014481,CDM,82330,CPT,300,RC,,,,BOTH,,,95,85.5,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,48.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,90.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,46.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.1,91.2,
HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES #,Px00030113913,CDM,83883,CPT,300,RC,,,,BOTH,,,95,85.5,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,48.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,90.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,46.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.1,91.2,
HC DNA ANTIBODY NATIVE/DOUBLE STRANDED,Px00030210470,CDM,86225,CPT,300,RC,,,,BOTH,,,95,85.5,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,48.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,90.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,46.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.1,91.2,
HC DNA ANTIBODY NATIVE/DOUBLE STRANDED #,Px00030200677,CDM,86225,CPT,300,RC,,,,BOTH,,,95,85.5,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,74.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,48.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,79.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,74.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.4,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,48.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.25,,,85.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.5,,,90.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.55,,,46.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.1,91.2,
HC ASSAY OF METANEPHRINES,Px00030112181,CDM,83835,CPT,300,RC,,,,BOTH,,,95.54,85.99,90.76,,,85.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.52,,,74.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.99,,,79.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.99,,,48.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.99,,,79.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.81,,,48.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.99,,,85.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.72,,,91.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.22,,,74.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.28,,,74.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.9,,,87.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.81,,,48.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.21,,,81.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.76,,,85.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.99,,,90.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,46.81,,,46.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.52,91.72,
MULTIPLE VITAMIN INJ,Rx54643786201,CDM,,,250,RC,54643-7862-01,NDC,,BOTH,1,EA,95.91,86.32,91.11,,,65.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.81,,,56.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.32,,,60.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.32,,,36.925,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.32,,,60.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47,,,36.925,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.32,,,65.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.07,,,69.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.49,,,56.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.47,,,56.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,66.665,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47,,,36.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.52,,,61.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.11,,,65.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.32,,,68.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47,,,47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.81,92.07,
HC VENTILATOR CIRCUIT W/PEEP (ER),Sx00001CV8015,CDM,,,270,RC,,,,BOTH,,,95.96,86.36,91.16,,,86.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.85,,,74.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.36,,,79.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.36,,,48.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.36,,,79.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,48.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.36,,,86.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.12,,,92.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.53,,,74.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.49,,,74.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.28,,,88.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,48.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.57,,,81.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,86.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.36,,,91.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,47.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.85,92.12,
HC K-WIRE 110MM,Sx000451-0016,CDM,,,270,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
HC ENDODRAPE COLONOSCOPY DISP DRAPE SYSTEM,Sx00000068659,CDM,,,270,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
"HC STIMULATING NERVE BLOCK NEEDLE W/ FACET S TIP 20G X 4""",Sx00001287-95,CDM,,,270,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
HC DRUG SCREEN QUANTITATIVE TACROLIMUS #,Px00030100543,CDM,80197,CPT,300,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
HC DRUG SCREEN QUANTITATIVE TACROLIMUS,Px00030014892,CDM,80197,CPT,300,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
HC LYME DISEASE ANTIBODY,Px00030010731,CDM,86618,CPT,300,RC,,,,BOTH,,,96,86.4,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.88,,,74.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,48.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,79.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.16,,,92.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.51,,,74.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.32,,,88.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,48.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.6,,,81.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,86.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,47.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.88,92.16,
HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM,Px00098110480,CDM,29515,CPT,981,RC,,,,OUTPATIENT,,,166,149.4,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.04,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.33,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.3,,,159.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.43,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.43,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.62,,,152.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.91,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.62,,,141.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.25,,,157.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.43,,,49.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,49.43,92.25,
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,Px00030112898,CDM,83520,CPT,300,RC,,,,BOTH,,,97,87.3,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.66,,,75.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,49.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.12,,,93.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.3,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.01,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.24,,,89.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.45,,,82.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,92.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,47.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.66,93.12,
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,Px00030100121,CDM,83520,CPT,300,RC,,,,BOTH,,,97,87.3,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.66,,,75.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,49.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.12,,,93.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.3,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.01,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.24,,,89.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.45,,,82.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,92.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,47.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.66,93.12,
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS,Px00030110765,CDM,83520,CPT,300,RC,,,,BOTH,,,97,87.3,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.66,,,75.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,49.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,80.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.12,,,93.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.3,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.01,,,75.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.24,,,89.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,49.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.45,,,82.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.15,,,87.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.3,,,92.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.53,,,47.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.66,93.12,
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH #,Px00030100377,CDM,83521,CPT,300,RC,,,,BOTH,,,97.4,87.66,92.53,,,87.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.97,,,75.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.66,,,81.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.66,,,49.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.66,,,81.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.73,,,49.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.66,,,87.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.59,,,75.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.2,,,75.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.61,,,89.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.73,,,49.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.79,,,82.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.53,,,87.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.66,,,92.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,47.73,,,47.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,75.97,93.5,
HC DRUG ASSAY LACOSAMIDE #,Px00030110241,CDM,80235,CPT,300,RC,,,,BOTH,,,98,88.2,93.1,,,88.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.44,,,76.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,81.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,49.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,81.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,49.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,94.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.03,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.5,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.16,,,90.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,49.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,83.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.1,,,88.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,48.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.44,94.08,
NICARDIPINE HCL IV SOLN 2.5 MG/ML,Rx00143968901,CDM,J2404,HCPCS,636,RC,143968901,NDC,,BOTH,1,ML,98.01,88.21,93.11,,,88.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.45,,,76.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,81.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,49.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,81.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,49.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,88.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.09,,,94.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.04,,,76.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,76.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.17,,,90.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,49.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.31,,,83.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.11,,,88.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,93.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.02,,,48.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.45,94.09,
HC DRESSING MEPITEL 6.8X10,Sx00000289700,CDM,,,270,RC,,,,BOTH,,,98.04,88.24,93.14,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.47,,,76.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,81.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,49.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,81.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.04,,,49.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.12,,,94.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.06,,,76.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.52,,,76.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.2,,,90.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.04,,,49.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.33,,,83.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.14,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.24,,,93.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.04,,,48.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.47,94.12,
EMTRICITABINE-TENOFOVIR DF 200-300 MG & RALTEGRAVIR 400 MG (ED PREPACK-OR) PO TABS KIT,Rx00000005894,CDM,,,250,RC,00000-0058-94,NDC,,BOTH,1,EA,98.15,88.34,93.24,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.56,,,76.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.34,,,81.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.34,,,50.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.34,,,81.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.09,,,50.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.34,,,88.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.22,,,94.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.14,,,76.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.57,,,76.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.3,,,90.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.09,,,50.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.43,,,83.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.24,,,88.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.34,,,93.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.09,,,48.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.56,94.22,
HC CATH 14FR COUDE SILICONE,Sx00171305140,CDM,,,270,RC,,,,BOTH,,,98.4,85.92,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.75,,,76.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,50.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,94.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.32,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.7,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,90.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.64,,,83.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,93.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,48.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.75,94.46,
HC CATH 16FR COUDE SILICONE - TELEFLEX ITEM,Sx00171305160,CDM,,,270,RC,,,,BOTH,,,98.4,85.92,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.75,,,76.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,50.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,94.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.32,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.7,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,90.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.64,,,83.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,93.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,48.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.75,94.46,
HC CATH 18FR COUDE FOLEY SILICONE,Sx00171305180,CDM,,,270,RC,,,,BOTH,,,98.4,85.92,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.75,,,76.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,50.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,81.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,94.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.32,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.7,,,76.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,90.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,50.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.64,,,83.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.48,,,88.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.56,,,93.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.22,,,48.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.75,94.46,
CEFTRIAXONE SODIUM FOR IV SOLN 1 GM AND DEXTROSE 3.74% 50 ML,Rx00264315311,CDM,J0696,HCPCS,636,RC,264315311,NDC,,BOTH,50,ML,98.46,83.82,93.54,,,88.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.8,,,76.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.61,,,81.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.61,,,50.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.61,,,81.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,50.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.61,,,88.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.52,,,94.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.37,,,76.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,76.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,90.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,50.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.69,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.54,,,88.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.61,,,93.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.25,,,48.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.8,94.52,
HC SECURESEAL TOPICAL ADHESIVE,Px00011016WNH,CDM,,,270,RC,,,,BOTH,,,98.88,88.99,93.94,,,89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.13,,,77.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.99,,,82.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.99,,,50.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.99,,,82.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,50.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.99,,,88.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.92,,,94.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.68,,,77.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,48.94,,,77.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.97,,,90.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,50.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.05,,,84.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.94,,,89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.99,,,93.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.45,,,48.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.13,94.92,
HC ASSAY OF PHENYTOIN TOTAL,Px00030112228,CDM,80185,CPT,300,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
HC CREATINE KINASE MB FRACTION ONLY #,Px00030100587,CDM,82553,CPT,300,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
HC CREATINE KINASE MB FRACTION ONLY #,Px00030100762,CDM,82553,CPT,300,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
HC CK-MB,Px00030014567,CDM,82553,CPT,300,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
HC TRANSFERRIN,Px00030016076,CDM,84446,CPT,300,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
HC OPERATING ROOM SERVICES LEVEL 8 PER MIN,Px00036010226,CDM,,,360,RC,,,,BOTH,,,99,89.1,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.22,,,77.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,50.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,82.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.77,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.08,,,91.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,50.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.15,,,84.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,89.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.1,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.51,,,48.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.22,95.04,
DOXYCYCLINE HYCLATE FOR INJ 100 MG,Rx72266023701,CDM,,,250,RC,72266-0237-01,NDC,,BOTH,100,ME,99.03,89.13,94.08,,,94.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.24,,,77.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.13,,,89.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.13,,,89.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.13,,,89.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.52,,,48.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.13,,,89.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.07,,,95.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.79,,,72.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.01,,,49.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.11,,,91.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.52,,,48.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.18,,,84.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.08,,,94.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.13,,,89.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,48.52,,,48.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.24,95.07,
SODIUM BICARBONATE IV SOLN 8.4%,Rx76329335201,CDM,,,250,RC,76329-3352-01,NDC,,BOTH,1,EA,99.9,82.01,94.91,,,89.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.92,,,77.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.91,,,83.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.91,,,50.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.91,,,83.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.95,,,50.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.91,,,89.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.9,,,95.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.43,,,77.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.44,,,77.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.91,,,91.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.95,,,50.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.92,,,84.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.91,,,89.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.91,,,94.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,48.95,,,48.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,77.92,95.9,
HC HIV-1/HIV-2 SINGLE ASSAY,Px00030210719,CDM,86703,CPT,300,RC,,,,BOTH,,,100,90,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78,,,78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,50.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96,,,96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92,,,92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78,96,
HC RUBELLA ANTIBODY,Px00030210766,CDM,86762,CPT,300,RC,,,,BOTH,,,100,90,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78,,,78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,50.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96,,,96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92,,,92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78,96,
HC H PYLORI ANTIGEN STOOL,Px00030610663,CDM,87338,CPT,300,RC,,,,BOTH,,,100,90,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78,,,78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,50.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96,,,96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92,,,92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78,96,
HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM #,Px00030011741,CDM,87880,CPT,300,RC,,,,BOTH,,,100,90,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78,,,78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,50.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,83.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96,,,96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92,,,92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,50.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85,,,85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95,,,90,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90,,,95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49,,,49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78,96,
HC SNARE POLYPECTOMY 2.3 DISPOSABLE 240 CM MEDIUM,Sx00000060418,CDM,,,270,RC,,,,BOTH,,,100.04,90.04,95.04,,,90.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.03,,,78.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,83.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,50.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,83.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,50.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,90.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.53,,,78.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.51,,,78.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,92.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,50.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.03,,,85.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,90.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.02,,,49.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.03,96.04,
HC SENSORMAT BED CHECK,Px00000956WNH,CDM,,,270,RC,,,,BOTH,,,100.45,90.41,95.43,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.35,,,78.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,83.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,51.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,83.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,51.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.43,,,96.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.83,,,78.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.71,,,78.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.41,,,92.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,51.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.38,,,85.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.43,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,95.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,49.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.35,96.43,
HC SENSORMAT BED CHECK 30 DAY LIFE,Sx00000092010,CDM,,,270,RC,,,,BOTH,,,100.45,90.41,95.43,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.35,,,78.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,83.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,51.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,83.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,51.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.43,,,96.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.83,,,78.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.71,,,78.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.41,,,92.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,51.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.38,,,85.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.43,,,90.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.41,,,95.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.22,,,49.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.35,96.43,
HC SENSORMAT LT CHAIR,Sx00000093010,CDM,,,270,RC,,,,BOTH,,,100.5,90.45,95.48,,,90.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.39,,,78.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.45,,,83.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.45,,,51.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.45,,,83.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,51.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.45,,,90.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.48,,,96.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.87,,,78.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.74,,,78.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.46,,,92.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,51.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.43,,,85.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.48,,,90.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.45,,,95.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.25,,,49.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.39,96.48,
"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)",Rx63323017005,CDM,,,250,RC,63323-0170-05,NDC,,BOTH,5,ML,100.64,90.58,95.61,,,90.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.5,,,78.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,83.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,51.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,83.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.31,,,51.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,90.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.61,,,96.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.97,,,78.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.81,,,78.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.59,,,92.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.31,,,51.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.54,,,85.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.61,,,90.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.58,,,95.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.31,,,49.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.5,96.61,
HC ANKLE BRACE MED BLK LEFT,Px00002406WNH,CDM,L1906,CPT,274,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC ANKLE BRACE LG BLK,Px00002407WNH,CDM,L1906,CPT,274,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR #,Px00030500092,CDM,85230,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC FACTOR VIII,Px00030510085,CDM,85240,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL,Px00030510373,CDM,85598,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC MICROSOMAL ANTIBODIES EACH #,Px00030200114,CDM,86376,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC MICROSOMAL ANTIBODIES EACH #,Px00030200152,CDM,86376,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC MICROSOMAL ANTIBODIES EACH #,Px00030200536,CDM,86376,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC MICROSOMAL ANTIBODY -THROID PEROXIDASE,Px00030010660,CDM,86376,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
HC MICROSOMAL ANTIBODY,Px00030010663,CDM,86376,CPT,300,RC,,,,BOTH,,,101,90.9,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.78,,,78.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,51.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,84.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.96,,,96.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,78.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.92,,,92.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,51.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.85,,,85.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,90.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,95.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.49,,,49.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,78.78,96.96,
PHENYLEPHRINE HCL OPHTH SOLN 2.5%,Rx42702010215,CDM,,,250,RC,42702-0102-15,NDC,,BOTH,1,EA,101.43,91.29,96.36,,,96.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.12,,,79.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.29,,,91.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.29,,,91.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.29,,,91.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.7,,,49.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.29,,,91.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.37,,,97.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.55,,,74.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.2,,,50.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.32,,,93.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.7,,,49.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.22,,,86.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.36,,,96.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.29,,,91.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.7,,,49.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.12,97.37,
HC BRACE ANKLE MED BK LF,Px00002405WNH,CDM,L1906,CPT,274,RC,,,,BOTH,,,101.82,91.64,96.73,,,91.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.42,,,79.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.64,,,84.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.64,,,51.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.64,,,84.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.89,,,51.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.64,,,91.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.84,,,79.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.39,,,79.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.67,,,93.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.89,,,51.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.55,,,86.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.73,,,91.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.64,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.89,,,49.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.42,97.75,
METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV),Rx00143985001,CDM,J2930,HCPCS,636,RC,143985001,NDC,,BOTH,500,ME,101.92,91.79,96.82,,,96.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,79.5,,,79.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.73,,,91.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.73,,,91.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.73,,,91.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.94,,,49.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.73,,,91.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.84,,,97.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,74.91,,,74.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,49.94,,,49.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.77,,,93.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.94,,,49.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.63,,,86.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.82,,,96.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.73,,,91.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,49.94,,,49.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.5,97.84,
HC PROMOGRAN PRISMA,Px00012430WNH,CDM,,,270,RC,,,,BOTH,,,101.94,91.75,96.84,,,91.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.51,,,79.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,84.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,51.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,84.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.95,,,51.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,91.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.86,,,97.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.93,,,79.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.45,,,79.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.78,,,93.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.95,,,51.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.65,,,86.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.84,,,91.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,96.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.95,,,49.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.51,97.86,
HC ALGER CHUCK & BURR ASSEMBLY,Px00002275WNH,CDM,,,270,RC,,,,BOTH,,,102,91.8,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,51.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,97.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.48,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,93.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.7,,,86.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.56,97.92,
HC ALGERBRUSH II BURRCHUCK 1-1MM,Sx000000CB2-1,CDM,,,270,RC,,,,BOTH,,,102,91.8,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,51.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,97.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.48,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,93.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.7,,,86.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.56,97.92,
HC PREALBUMIN,Px00030112045,CDM,84134,CPT,300,RC,,,,BOTH,,,102,91.8,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.56,,,79.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,51.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,84.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,97.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.48,,,79.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,93.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,51.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.7,,,86.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,49.98,,,49.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.56,97.92,
HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID,Px00030010822,CDM,86665,CPT,300,RC,,,,BOTH,,,102.31,92.08,97.19,,,92.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.8,,,79.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.08,,,85.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.08,,,52.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.08,,,85.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.13,,,52.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.08,,,92.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.22,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.2,,,79.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.63,,,79.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.13,,,94.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.13,,,52.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.96,,,86.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.19,,,92.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.08,,,97.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.13,,,50.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,79.8,98.22,
"HC ANGIOCATH 14G X 3.25""",Px00000191WNH,CDM,,,270,RC,,,,BOTH,,,102.6,92.34,97.47,,,92.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.03,,,80.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,85.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,52.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,85.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.27,,,52.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,92.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.5,,,98.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.41,,,80.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.78,,,80.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.39,,,94.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.27,,,52.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.21,,,87.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.47,,,92.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,97.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.27,,,50.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.03,98.5,
HC PR ED 29126 APPLY FOREARM SPLINT DYN CDM,Px00098110470,CDM,29126,CPT,981,RC,,,,OUTPATIENT,,,179,161.1,100.24,,,161.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.57,,,139.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.88,,,149,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.88,,,91.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.88,,,149,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.7,,,91.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.14,,,161.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.45,,,171.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.3,,,139.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.3,,,139.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.03,,,164.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.78,,,91.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.03,,,152.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.24,,,161.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.55,,,170.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.3,,,49.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,49.3,98.55,
HC PR 58611 LIGATE OVIDUCT(S) ADD-ON,Px00097511107,CDM,58611,CPT,975,RC,,,,BOTH,,,182,163.8,101.92,,,163.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.71,,,141.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.75,,,151.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.75,,,92.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.75,,,151.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.15,,,92.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,163.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.1,,,174.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,141.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,141.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,167.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.47,,,92.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,154.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.92,,,163.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.55,,,172.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,393.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.5,98.55,
IRON SUCROSE INJ 20 MG/ML (FE EQUIV),Rx00517234001,CDM,J1756,HCPCS,636,RC,517234001,NDC,,BOTH,1,ML,102.9,92.61,97.76,,,97.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.26,,,80.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,50.42,,,50.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,98.78,,,98.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,75.63,,,75.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,50.42,,,50.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.67,,,94.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,50.42,,,50.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,87.47,,,87.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.76,,,97.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,50.42,,,50.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.26,98.78,
HC FLUID WARMER TUBING W/EXT,Px00007994WNH,CDM,,,270,RC,,,,BOTH,,,102.9,92.61,97.76,,,92.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.26,,,80.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,85.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,52.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,85.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.42,,,52.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,92.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.78,,,98.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.63,,,80.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.93,,,80.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.67,,,94.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.42,,,52.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,87.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,92.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,97.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.42,,,50.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.26,98.78,
HC DRUG SCREEN QUANTITATIVE VANCOMYCIN #,Px00030100544,CDM,80202,CPT,300,RC,,,,BOTH,,,103,92.7,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.34,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.88,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.71,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.97,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.76,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,50.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.34,98.88,
HC ASSAY OF VANCOMYCIN,Px00030110602,CDM,80202,CPT,300,RC,,,,BOTH,,,103,92.7,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.34,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.88,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.71,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.97,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.76,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,50.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.34,98.88,
HC CANALITH REPOSITION PROC,Px00042010108,CDM,95992,CPT,420,RC,,,,BOTH,,,103,92.7,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.34,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.88,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.71,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.97,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.76,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.55,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.85,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.7,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.47,,,50.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.34,98.88,
HC HEPATITIS C AB TEST,Px00030210798,CDM,86803,CPT,300,RC,,,,BOTH,,,103.23,92.91,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.52,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,54.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.1,,,103.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.87,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.09,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.97,,,98.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.75,,,91.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,102.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,50.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.52,99.1,
HC HEPATITIS C ANTIBODY #,Px00030200683,CDM,86803,CPT,300,RC,,,,BOTH,,,103.23,92.91,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.52,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,54.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.1,,,103.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.87,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.09,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.97,,,98.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.75,,,91.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,102.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,50.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.52,99.1,
HC HEPATITIS C ANTIBODY #,Px00030200688,CDM,86803,CPT,300,RC,,,,BOTH,,,103.23,92.91,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.52,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,54.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.1,,,103.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.87,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.09,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.97,,,98.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.75,,,91.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,102.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,50.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.52,99.1,
HC HEPATITIS C ANTIBODY #,Px00030200689,CDM,86803,CPT,300,RC,,,,BOTH,,,103.23,92.91,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.52,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,54.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.1,,,103.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.87,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.09,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.97,,,98.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.75,,,91.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,102.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,50.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.52,99.1,
HC HEP C ANTIBODY (HCV),Px00030011511,CDM,86803,CPT,300,RC,,,,BOTH,,,103.23,92.91,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.52,,,83.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,54.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.1,,,103.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.87,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.09,,,83.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.97,,,98.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,54.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.75,,,91.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.07,,,96.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.91,,,102.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.58,,,50.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.52,99.1,
HC CORTEX SCREW TI 3.5X26MM SELF TAP,Sx00000661426,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,103.53,93.18,98.35,,,93.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.75,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.18,,,86.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.18,,,52.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.18,,,86.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.73,,,52.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.18,,,93.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.39,,,99.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.09,,,80.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.24,,,80.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.25,,,95.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.73,,,52.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88,,,88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.35,,,93.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.18,,,98.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.73,,,50.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.75,99.39,
IRON SUCROSE INJ 20 MG/ML (FE EQUIV),Rx00517234099,CDM,J1756,HCPCS,636,RC,517234099,NDC,,BOTH,1,ML,103.66,93.29,98.48,,,93.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,80.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.29,,,86.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.29,,,52.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.29,,,86.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.79,,,52.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.29,,,93.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.51,,,99.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.19,,,80.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.79,,,80.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,95.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.79,,,52.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.11,,,88.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.48,,,93.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.29,,,98.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.79,,,50.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,80.85,99.51,
HC BLOOD CULTURE FOR BACTERIA,Px00030610301,CDM,87040,CPT,300,RC,,,,BOTH,,,104,93.6,98.8,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.12,,,81.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.44,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.47,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.68,,,95.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.4,,,88.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.8,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,98.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,50.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.12,99.84,
HC XR ELBOW LIMITED,Px00032010086,CDM,73070,CPT,320,RC,,,,BOTH,,,104,93.6,98.8,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.12,,,81.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,86.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.44,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.47,,,81.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.68,,,95.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.4,,,88.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.8,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,98.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,50.96,,,50.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.12,99.84,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx00075062001,CDM,J1650,HCPCS,636,RC,75062001,NDC,,BOTH,0.4,ML,104.23,93.81,99.02,,,99.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,81.3,,,81.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.81,,,93.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.81,,,93.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.81,,,93.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.07,,,51.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.81,,,93.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.06,,,100.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.61,,,76.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.07,,,51.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.89,,,95.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.07,,,51.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.6,,,88.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,99.02,,,99.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.81,,,93.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.07,,,51.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.3,100.06,
DOXYCYCLINE HYCLATE FOR INJ 100 MG,Rx67457043700,CDM,,,250,RC,67457-0437-00,NDC,,BOTH,100,ME,104.3,93.87,99.09,,,99.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,81.35,,,81.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.87,,,93.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.87,,,93.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.87,,,93.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.11,,,51.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.87,,,93.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.13,,,100.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.66,,,76.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.62,,,51.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.96,,,95.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.11,,,51.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.66,,,88.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,99.09,,,99.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.87,,,93.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.11,,,51.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.35,100.13,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx00075801410,CDM,J1650,HCPCS,636,RC,75801410,NDC,,BOTH,0.4,ML,104.67,94.2,99.44,,,99.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,81.64,,,81.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.2,,,94.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.2,,,94.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.2,,,94.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.29,,,51.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.2,,,94.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.48,,,100.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.93,,,76.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,51.29,,,51.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.3,,,96.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.29,,,51.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.97,,,88.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,99.44,,,99.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.2,,,94.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.29,,,51.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.64,100.48,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML,Rx00075801401,CDM,J1650,HCPCS,636,RC,75801401,NDC,,BOTH,0.4,ML,104.67,94.2,99.44,,,94.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.64,,,81.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.2,,,87.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.2,,,53.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.2,,,87.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.29,,,53.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.2,,,94.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.48,,,100.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.93,,,81.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.29,,,81.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.3,,,96.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.29,,,53.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.97,,,88.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.44,,,94.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.2,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.29,,,51.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.64,100.48,
HC DERMACARRIER II RATIO 1.5:1 8X3 STERILE,Sx00-2195-012,CDM,,,270,RC,,,,BOTH,,,104.75,94.28,99.51,,,94.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.71,,,81.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.28,,,87.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.28,,,53.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.28,,,87.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.33,,,53.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.28,,,94.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.56,,,100.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.99,,,81.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.84,,,81.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.37,,,96.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.33,,,53.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.04,,,89.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.51,,,94.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.28,,,99.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.33,,,51.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.71,100.56,
HC MEPILEX BORDER AG DRESSING 4X8,Sx00000395890,CDM,,,270,RC,,,,BOTH,,,104.96,94.46,99.71,,,94.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.87,,,81.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,87.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,53.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,87.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.43,,,53.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,94.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.76,,,100.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.15,,,81.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,81.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.56,,,96.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.43,,,53.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.22,,,89.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.71,,,94.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.46,,,99.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.43,,,51.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.87,100.76,
HC PR ED 17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE CDM,Px00098100002,CDM,17250,CPT,981,RC,,,,OUTPATIENT,,,148,133.2,82.88,,,133.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,115.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.5,,,115.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.5,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.5,,,115.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.48,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.41,,,133.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.4,,,142.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,115.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.36,,,136.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.05,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.36,,,125.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.88,,,133.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,140.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,36.94,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,36.94,100.8,
HC PR 17250 CHEMICAL CAUTERY TISSUE,Px00098310353,CDM,17250,CPT,983,RC,,,,BOTH,,,270,243,151.2,,,243,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.02,,,210.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.75,,,201.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.75,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.75,,,201.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.48,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.41,,,243,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.5,,,259.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,210.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,210.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,248.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.05,,,42.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,229.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,243,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,256.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,36.94,,,36.94,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,36.94,100.8,
HC K-WIRE 0.062 in x 3 in,Sx0000AR-2663,CDM,,,270,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC GUIDE WIRE TROCAR TIP 1.35 MM,Sx0AR-8943-01,CDM,,,270,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC SCREW NON LOCKING 3.5X24MM LOW PROFILE CORTICAL,Sx0AR-8835-24,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC LO-PRO SCREW TM SS 3.5X12MM CORT,Sx0AR-8835-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC SCREW LO-PRO SS 4X22MM CANCLUS,Sx0AR-8840-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC DRUG ASSAY CARBAMAZEPINE -10 11-EPOXIDE #,Px00030100041,CDM,80161,CPT,300,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC GLUCOSE TOLERANCE(3 SPEC),Px00030112719,CDM,82951,CPT,300,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
HC MYOGLOBIN SERUM,Px00030112373,CDM,83874,CPT,300,RC,,,,BOTH,,,105,94.5,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.9,,,81.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,53.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,87.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.96,,,81.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,53.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.25,,,89.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.75,,,94.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.5,,,99.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.45,,,51.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,81.9,100.8,
CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML,Rx00143972401,CDM,J0735,HCPCS,636,RC,143972401,NDC,,BOTH,1,ML,105.16,222.35,99.9,,,94.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.02,,,82.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.64,,,87.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.64,,,53.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.64,,,87.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.53,,,53.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.64,,,94.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.95,,,101.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.29,,,82.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.53,,,82.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.75,,,96.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.53,,,53.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.39,,,89.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,94.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.64,,,99.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.53,,,51.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.02,100.95,
CALCIUM CHLORIDE INJ 10%,Rx00409492834,CDM,,,250,RC,00409-4928-34,NDC,,BOTH,1,EA,105.43,73.57,100.16,,,88.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.24,,,77.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.89,,,82.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.89,,,50.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.89,,,82.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.66,,,50.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.89,,,88.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.21,,,94.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.49,,,77.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.18,,,77.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97,,,90.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.66,,,50.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.62,,,84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.16,,,88.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.89,,,93.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.66,,,51.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.24,101.21,
HC PR ED 29425 APPLY SHORT WALKING LEG CAST CDM,Px00098110477,CDM,29425,CPT,981,RC,,,,OUTPATIENT,,,177,159.3,99.12,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.43,,,138.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,147.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,147.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.97,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.24,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.35,,,169.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.89,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.89,,,138.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.89,,,162.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.51,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.89,,,150.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.12,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.25,,,168.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.89,,,53.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,53.89,101.25,
HC SCREW SELF TAP 2.7MM CORTICAL SS,Sx00000349620,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,105.6,95.04,100.32,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.37,,,82.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,87.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,53.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,87.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.74,,,53.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.38,,,101.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.62,,,82.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.26,,,82.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,97.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.74,,,53.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.76,,,89.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.32,,,95.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.04,,,100.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.74,,,51.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.37,101.38,
GATIFLOXACIN OPHTH SOLN 0.5%,Rx50383018902,CDM,,,250,RC,50383-0189-02,NDC,,BOTH,1,EA,105.81,95.23,100.52,,,100.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,82.53,,,82.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.58,,,101.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.77,,,77.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.37,,,52.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.35,,,97.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.94,,,89.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.52,,,100.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.53,101.58,
GATIFLOXACIN OPHTH SOLN 0.5%,Rx60758061525,CDM,,,250,RC,60758-0615-25,NDC,,BOTH,1,EA,105.81,95.23,100.52,,,100.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,82.53,,,82.53,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.58,,,101.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,77.77,,,77.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.37,,,52.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.35,,,97.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.94,,,89.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.52,,,100.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.23,,,95.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,51.85,,,51.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.53,101.58,
HC ASSAY OF ERYTHROPOIETIN,Px00030013647,CDM,82668,CPT,300,RC,,,,BOTH,,,105.97,95.37,100.67,,,95.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.66,,,82.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,88.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,88.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.93,,,54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,95.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.73,,,101.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.89,,,82.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,82.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.49,,,97.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.93,,,54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.07,,,90.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.67,,,95.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.37,,,100.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.93,,,51.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.66,101.73,
HC PR 99232 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES CDM,Px00098710012,CDM,99232,CPT,987,RC,,,,BOTH,,,166,149.4,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.24,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.21,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.41,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.3,,,159.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.62,,,152.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.62,,,141.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.75,,,157.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,101.75,
HC ADMIN INFLUENZA VIRUS VAC,Px00077110003,CDM,90471,CPT,771,RC,,,,BOTH,,,106,95.4,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.68,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,133.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,133.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.76,,,101.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.52,,,97.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,90.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.68,101.76,
HC ADMIN HEPATITIS B VACCINE,Px00077110005,CDM,90471,CPT,771,RC,,,,BOTH,,,106,95.4,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.68,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,133.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,133.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.76,,,101.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.52,,,97.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,90.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.68,101.76,
HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS,Px00030114380,CDM,80306,CPT,300,RC,,,,BOTH,,,106,95.4,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.68,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,54.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.76,,,101.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.46,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.52,,,97.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,90.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.68,101.76,
HC XR PEDIATRIC FOREIGN BODY 1 VIEW,Px00032010320,CDM,76010,CPT,320,RC,,,,BOTH,,,106,95.4,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.68,,,82.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,54.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,88.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.76,,,101.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.46,,,82.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.52,,,97.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,54.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,90.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,95.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,51.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.68,101.76,
HC XR CHEST 2 VIEWS,Px00032410015,CDM,71046,CPT,320,RC,,,,BOTH,,,202,95.4,100.7,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.68,,,157.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,167.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,103.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,167.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,103.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.76,,,193.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,157.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.46,,,157.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.52,,,185.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,103.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,171.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.4,,,191.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,51.94,,,98.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.68,101.76,
HC INTRODUCER MICROPUNCTR SET 4FR 10CM,Sx00000G47940,CDM,,,270,RC,,,,BOTH,,,106.3,95.67,100.99,,,95.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.91,,,82.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.67,,,88.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.67,,,54.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.67,,,88.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.09,,,54.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.67,,,95.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.05,,,102.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.13,,,82.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.61,,,82.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.8,,,97.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.09,,,54.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.36,,,90.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.99,,,95.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.67,,,100.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.09,,,52.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.91,102.05,
HC PAD SENSA TRAC #M8275057/10.S,Px00008639WNH,CDM,,,270,RC,,,,BOTH,,,106.32,95.69,101,,,95.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.93,,,82.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.69,,,88.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.69,,,54.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.69,,,88.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.1,,,54.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.69,,,95.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.07,,,102.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.15,,,82.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.62,,,82.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.81,,,97.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.1,,,54.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.37,,,90.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101,,,95.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.69,,,101,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.1,,,52.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,82.93,102.07,
HC PR ED 64450 NERVE BLOCK OTHER PERIPHERAL CDM,Px00098110817,CDM,64450,CPT,981,RC,,,,OUTPATIENT,,,99,89.1,55.44,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.68,,,77.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,81.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,47.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.88,,,81.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.44,,,47.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.45,,,62.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.38,,,77.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.38,,,77.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.43,,,91.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.59,,,50.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.43,,,84.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.44,,,89.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.16,,,94.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.38,,,40.38,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.38,102.16,
CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML,Rx39822200001,CDM,J0735,HCPCS,636,RC,39822200001,NDC,,BOTH,1,ML,106.71,96.1,101.37,,,101.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,83.23,,,83.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.29,,,52.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,102.44,,,102.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,78.43,,,78.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,52.29,,,52.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.17,,,98.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.29,,,52.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.7,,,90.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.37,,,101.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.04,,,96.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,52.29,,,52.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,83.23,102.44,
LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),Rx00009514001,CDM,J2020,HCPCS,636,RC,9514001,NDC,,BOTH,300,ML,107.32,96.59,101.95,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.71,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,89.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,54.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,89.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,54.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.03,,,103.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.88,,,83.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,83.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.73,,,98.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,54.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.22,,,91.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.95,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,101.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,52.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,83.71,103.03,
"LINEZOLID IV SOLN 200 MG/100ML (2 MG/ML),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%",Rx00009514001,CDM,J2020,HCPCS,636,RC,9514001,NDC,,BOTH,100,ML,107.32,96.59,101.95,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.71,,,83.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,89.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,54.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,89.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,54.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.03,,,103.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.88,,,83.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,83.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.73,,,98.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,54.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.22,,,91.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.95,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.59,,,101.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.59,,,52.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,83.71,103.03,
"HC ABDOMINAL BINDER 9"" 27-48 UNIV",Px00011859WNH,CDM,,,270,RC,,,,BOTH,,,107.64,96.88,102.26,,,96.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.96,,,83.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,89.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,54.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,89.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.74,,,54.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,96.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.33,,,103.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.12,,,83.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.27,,,83.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.03,,,99.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.74,,,54.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.49,,,91.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.26,,,96.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.88,,,102.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.74,,,52.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,83.96,103.33,
HC BRACE ANKLE SM BLK ROYCE SLIM FIT DESIGN,SxB-212010002,CDM,L1906,HCPCS,274,RC,,,,BOTH,,,107.94,100.44,102.54,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.19,,,87.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,92.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,56.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,92.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,56.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.62,,,107.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.34,,,87.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.42,,,87.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.3,,,102.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,56.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,94.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.54,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,106.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,52.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.19,103.62,
HC BRACE ANKLE MED BLK EXOFORM FORM FIT,SxB-212010003,CDM,L1906,HCPCS,274,RC,,,,BOTH,,,107.94,100.44,102.54,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.19,,,87.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,92.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,56.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,92.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,56.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.62,,,107.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.34,,,87.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.42,,,87.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.3,,,102.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,56.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,94.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.54,,,100.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,106.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,52.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.19,103.62,
HC BRACE ANKLE LG BLK ROYCE SLIM FIT DESIGN,SxB-212010004,CDM,L1906,HCPCS,274,RC,,,,BOTH,,,107.94,124.92,102.54,,,124.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.19,,,108.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,115.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,70.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,115.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,70.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,124.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.62,,,133.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.34,,,108.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.42,,,108.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.3,,,127.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,70.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.75,,,117.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.54,,,124.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.15,,,131.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.89,,,52.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.19,103.62,
HC STABILIZER EZ-IO,Px00009900WNH,CDM,,,270,RC,,,,BOTH,,,108,97.2,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,55.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.38,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.45,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.36,,,99.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,52.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.24,103.68,
HC TRIMANO DRAPE,Sx0000AR-1648,CDM,,,270,RC,,,,BOTH,,,108,97.2,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,55.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.38,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.45,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.36,,,99.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,52.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.24,103.68,
HC STABILIZER EZ-IO,Sx9066-VC-005,CDM,,,270,RC,,,,BOTH,,,108,112.5,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,55.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.38,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.45,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.36,,,99.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,52.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.24,103.68,
HC XR FOREARM 2 VIEWS,Px00032010112,CDM,73090,CPT,320,RC,,,,BOTH,,,108,97.2,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.24,,,84.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,55.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,89.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.38,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.45,,,84.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.36,,,99.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,55.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,97.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.2,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,52.92,,,52.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.24,103.68,
HC PR 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL  CDM,Px00098311350,CDM,16020,CPT,983,RC,,,,BOTH,,,124,111.6,69.44,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.07,,,96.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.5,,,103.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.5,,,63.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.5,,,103.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.37,,,63.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.19,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.2,,,119.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,96.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.68,,,114.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.75,,,63.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.68,,,105.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.44,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,117.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,55.1,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,55.1,103.95,
HC PR ED 16020 DRESS/DEBRID P-THICK BURN S <5% TBSA CDM,Px00098110510,CDM,16020,CPT,981,RC,,,,OUTPATIENT,,,130,117,72.8,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.07,,,101.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,108.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,108.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.37,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.19,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.5,,,124.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,101.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,119.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.75,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,110.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.8,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,123.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.1,,,55.1,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,55.1,103.95,
HC CUFF TOURNIQUET DISPOSABLE 24 IN SINGLE BLADDER,Sx60-7075-104,CDM,,,270,RC,,,,BOTH,,,108.64,97.78,103.21,,,97.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.74,,,84.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.78,,,90.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.78,,,55.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.78,,,90.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.23,,,55.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.78,,,97.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.29,,,104.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,79.85,,,84.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.77,,,84.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.95,,,99.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.23,,,55.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,92.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.21,,,97.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.78,,,103.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.23,,,53.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,84.74,104.29,
HC INHIBIN A #,Px00030200110,CDM,86336,CPT,300,RC,,,,BOTH,,,109,98.1,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.02,,,85.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,55.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.64,,,104.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.12,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.28,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.65,,,92.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,103.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,53.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.02,104.64,
HC INHIBIN A #,Px00030200120,CDM,86336,CPT,300,RC,,,,BOTH,,,109,98.1,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.02,,,85.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,55.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.64,,,104.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.12,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.28,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.65,,,92.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,103.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,53.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.02,104.64,
HC INHIBIN A #,Px00030200532,CDM,86336,CPT,300,RC,,,,BOTH,,,109,98.1,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.02,,,85.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,55.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.64,,,104.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.12,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.28,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.65,,,92.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,103.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,53.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.02,104.64,
HC INHIBIN A,Px00030011698,CDM,86336,CPT,300,RC,,,,BOTH,,,109,98.1,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.02,,,85.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,55.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.64,,,104.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.12,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.28,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.65,,,92.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,103.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,53.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.02,104.64,
HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE #,Px00031010667,CDM,88341,CPT,300,RC,,,,BOTH,,,109,98.1,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.02,,,85.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,55.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,90.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.64,,,104.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.12,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.94,,,85.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.28,,,100.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,55.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.65,,,92.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.55,,,98.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.1,,,103.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.41,,,53.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.02,104.64,
HC DRESSING MEPILEX BOARDER 4X10 FOAMAG SELF ADHERENT,Sx00000395790,CDM,,,270,RC,,,,BOTH,,,109.1,98.19,103.65,,,98.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.1,,,85.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.19,,,90.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.19,,,55.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.19,,,90.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.46,,,55.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.19,,,98.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.74,,,104.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.19,,,85.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.99,,,85.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.37,,,100.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.46,,,55.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.74,,,92.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.65,,,98.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.19,,,103.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.46,,,53.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.1,104.74,
HC LIQUIBAND OCTYL TOPIC ADHESIVE 0.8ML SKIN GLUE,Sx00072014016,CDM,,,270,RC,,,,BOTH,,,109.18,98.26,103.72,,,98.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.16,,,85.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.26,,,90.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.26,,,55.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.26,,,90.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.5,,,55.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.26,,,98.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.81,,,104.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.25,,,85.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.03,,,85.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.45,,,100.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.5,,,55.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.8,,,92.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.72,,,98.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.26,,,103.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.5,,,53.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.16,104.81,
HC PR 29405 SHORT LEG CAST APPLICATION,Px00098311024,CDM,29405,CPT,983,RC,,,,BOTH,,,948,853.2,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.68,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.36,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,521.4,,,910.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.37,,,739.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.37,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,872.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.12,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,805.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,900.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.37,,,58.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,58.37,105.3,
HC PR 99238 HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/< CDM,Px00098710017,CDM,99238,CPT,987,RC,,,,BOTH,,,167,150.3,93.52,,,150.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.43,,,130.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.38,,,140.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.38,,,91.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.38,,,140.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,91.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.94,,,150.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.85,,,96.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,130.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,130.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.19,,,153.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.26,,,85.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.19,,,141.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.52,,,150.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.38,,,158.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,105.38,
IRON SUCROSE INJ 20 MG/ML (FE EQUIV),Rx00517234010,CDM,J1756,HCPCS,636,RC,517234010,NDC,,BOTH,1,ML,109.83,98.93,104.34,,,104.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,85.67,,,85.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,98.85,,,98.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,98.85,,,98.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,98.85,,,98.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.85,,,98.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,105.44,,,105.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,80.73,,,80.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.04,,,101.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.36,,,93.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.34,,,104.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,98.85,,,98.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,53.82,,,53.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.67,105.44,
HC FIBERWIRE 3-0 T-43 18 IN 15MM 3/8 CIRCLE,Sx0AR-7227-01,CDM,,,270,RC,,,,BOTH,,,110,99,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.8,,,85.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,56.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.44,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.2,,,101.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,104.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,53.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.8,105.6,
HC GUIDE WIRE .086mm W/TROCAR TIP,Sx0AR-8737-39,CDM,,,270,RC,,,,BOTH,,,110,99,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.8,,,85.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,56.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.44,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.2,,,101.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,104.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,53.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.8,105.6,
HC ASSAY OF AMMONIA #,Px00030112108,CDM,82140,CPT,300,RC,,,,BOTH,,,110,99,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.8,,,85.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,56.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.44,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.2,,,101.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,104.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,53.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.8,105.6,
HC T3 REVERSE ESOTERIX,Px00030015998,CDM,84482,CPT,300,RC,,,,BOTH,,,110,99,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.8,,,85.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,56.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.44,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.2,,,101.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,104.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,53.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.8,105.6,
HC XR HAND 2 VIEWS,Px00032010127,CDM,73120,CPT,320,RC,,,,BOTH,,,110,99,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.8,,,85.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,56.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,91.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.85,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.44,,,85.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.2,,,101.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,56.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.5,,,93.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.5,,,99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99,,,104.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,53.9,,,53.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,85.8,105.6,
HC SCREW NON LOCKING 3.5X16MM LOW PROFILE CORTICLE,Sx0AR-8835-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,110.25,99.23,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,56.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,105.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.03,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.56,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.71,,,93.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,104.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,54.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86,105.84,
HC SCREW NON LOCKING 3.5X18MM LOW PROFILE CORTICAL,Sx0AR-8835-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,110.25,99.23,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,56.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,105.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.03,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.56,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.71,,,93.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,104.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,54.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86,105.84,
HC SCREW NON LOCKING 3.5X20MM LOW PROFILE CORTICAL,Sx0AR-8835-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,110.25,99.23,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,56.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,91.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,105.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.03,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.56,,,86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,56.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.71,,,93.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.74,,,99.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,104.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.02,,,54.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86,105.84,
METHYLERGONOVINE MALEATE INJ 0.2 MG/ML,Rx00517074001,CDM,J2210,HCPCS,636,RC,517074001,NDC,,BOTH,1,ML,110.31,99.28,104.79,,,99.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.04,,,86.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,91.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,56.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,91.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.05,,,56.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,99.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.9,,,105.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.08,,,86.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.05,,,86.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.49,,,101.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.05,,,56.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.76,,,93.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.79,,,99.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,104.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.05,,,54.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.04,105.9,
HC DHEA SULFATE.,Px00030014685,CDM,82627,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY,Px00030210361,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY #,Px00030200113,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY #,Px00030200562,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY #,Px00030200563,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY #,Px00030200564,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY #,Px00030200676,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN AB,Px00030010478,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC THYROGLOBULIN ANTIBODY SCREEN,Px00030011019,CDM,86800,CPT,300,RC,,,,BOTH,,,111,99.9,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.58,,,86.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,56.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,92.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.56,,,106.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.59,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.93,,,86.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.12,,,102.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,56.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.35,,,94.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,99.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.9,,,105.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.39,,,54.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.58,106.56,
HC CPD BLOOD PACK ANTICOAGULANT DEX SOLUTION USP,Sx000004R3611,CDM,,,270,RC,,,,BOTH,,,111.21,54.46,105.65,,,100.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.74,,,86.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.09,,,92.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.09,,,56.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.09,,,92.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.49,,,56.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.09,,,100.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.76,,,106.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.74,,,86.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.04,,,86.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.31,,,102.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.49,,,56.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.53,,,94.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.65,,,100.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.09,,,105.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.49,,,54.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.74,106.76,
SODIUM BICARBONATE IV SOLN 4.2%,Rx00409553424,CDM,,,250,RC,00409-5534-24,NDC,,BOTH,1,EA,111.37,57.16,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,86.87,,,86.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.23,,,100.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.23,,,100.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.23,,,100.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.57,,,54.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,100.23,,,100.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,106.92,,,106.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,81.86,,,81.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.12,,,55.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.46,,,102.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.57,,,54.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.66,,,94.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.23,,,100.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,54.57,,,54.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.87,106.92,
DOBUTAMINE INJ 4 MG/ML IN D5W,Rx00338107702,CDM,J1250,HCPCS,636,RC,338107702,NDC,,BOTH,1,ML,111.37,98.71,105.8,,,100.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.87,,,86.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.23,,,92.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.23,,,56.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.23,,,92.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.57,,,56.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.23,,,100.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,106.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.86,,,86.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.57,,,86.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.46,,,102.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.57,,,56.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.66,,,94.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,100.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.23,,,105.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.57,,,54.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.87,106.92,
OPHTHALMIC IRRIGATION SOLUTION - EXTRAOCULAR,Rx00065053001,CDM,,,250,RC,00065-0530-01,NDC,,BOTH,1,EA,111.4,100.26,105.83,,,100.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.89,,,86.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.26,,,92.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.26,,,56.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.26,,,92.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.59,,,56.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.26,,,100.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.94,,,106.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.88,,,86.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.13,,,86.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.49,,,102.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.59,,,56.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.69,,,94.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.83,,,100.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.26,,,105.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.59,,,54.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,86.89,106.94,
HC PR ED 29505 APPLICATION LONG LEG SPLINT CDM,Px00098110479,CDM,29505,CPT,981,RC,,,,OUTPATIENT,,,206,185.4,115.36,,,185.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.79,,,160.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.75,,,171.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.75,,,104.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.75,,,171.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.29,,,104.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.2,,,185.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.3,,,197.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,160.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,160.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.42,,,189.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54,,,104.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.42,,,175.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.36,,,185.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.09,,,195.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,52.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,52.43,107.09,
HC BRACE ANKLE EXOFORM FIT,Px00032100WNH,CDM,L1906,CPT,274,RC,,,,BOTH,,,112,100.8,106.4,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.36,,,87.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,93.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,57.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,93.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,57.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.52,,,107.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,87.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.43,,,87.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.04,,,103.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,57.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.2,,,95.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.4,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,106.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,54.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,87.36,107.52,
HC ASSAY OF THYROGLOBULIN #,Px00030114160,CDM,84432,CPT,300,RC,,,,BOTH,,,112,100.8,106.4,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.36,,,87.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,93.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,57.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,93.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,57.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.52,,,107.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,87.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.43,,,87.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.04,,,103.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,57.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.2,,,95.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.4,,,100.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.8,,,106.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,54.88,,,54.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,87.36,107.52,
NICARDIPINE HCL IV SOLN 2.5 MG/ML,Rx00143954201,CDM,J2404,HCPCS,636,RC,143954201,NDC,,BOTH,1,ML,112.59,101.33,106.96,,,106.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,87.82,,,87.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.33,,,101.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.33,,,101.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.33,,,101.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.17,,,55.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.33,,,101.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,108.09,,,108.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,82.75,,,82.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,55.17,,,55.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.58,,,103.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.17,,,55.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.7,,,95.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,106.96,,,106.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.33,,,101.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.17,,,55.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,87.82,108.09,
HC NOSE TO TOES SURGICAL ORAL AND SKIN CLEANSING KIT,Sx00000009001,CDM,,,270,RC,,,,BOTH,,,112.74,101.47,107.1,,,101.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.94,,,87.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.47,,,93.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.47,,,57.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.47,,,93.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.24,,,57.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.47,,,101.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.23,,,108.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.86,,,87.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.8,,,87.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.72,,,103.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.24,,,57.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.83,,,95.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,101.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.47,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.24,,,55.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,87.94,108.23,
HC CORTISOL TOTAL #,Px00030100579,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC CORTISOL TOTAL #,Px00030100580,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC CORTISOL TOTAL #,Px00030100581,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC CORTISOL TOTAL #,Px00030100582,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC CORTISOL TOTAL #,Px00030100764,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC CORTISOL,Px00030014605,CDM,82533,CPT,300,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
HC XR SPINE 1 VIEW ANY LEVEL,Px00032010053,CDM,72020,CPT,320,RC,,,,BOTH,,,113,101.7,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.14,,,88.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,57.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,94.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.48,,,108.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.06,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.92,,,88.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.96,,,103.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,57.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.05,,,96.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,101.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.7,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.37,,,55.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.14,108.48,
"HC ANGIOCATH 16G X 5.25""",Px00002471WNH,CDM,,,270,RC,,,,BOTH,,,113.4,102.06,107.73,,,102.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.45,,,88.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,94.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,57.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,94.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.57,,,57.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,102.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.86,,,108.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.35,,,88.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.12,,,88.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.33,,,104.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.57,,,57.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.39,,,96.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.73,,,102.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,107.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.57,,,55.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.45,108.86,
HC PR ED 99283 VISIT LOW MDM CDM,Px00098110009,CDM,99283,CPT,981,RC,,,,OUTPATIENT,,,168,151.2,94.08,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.44,,,131.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,139.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,85.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105,,,139.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.68,,,85.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.3,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.4,,,161.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,131.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.76,,,154.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,85.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.72,,,142.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,151.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109,,,159.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,109,
HC DRUG SCREEN QUANT CLOZAPINE #,Px00030110128,CDM,80159,CPT,300,RC,,,,BOTH,,,113.65,102.29,107.97,,,102.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.65,,,88.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.29,,,94.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.29,,,57.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.29,,,94.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.69,,,57.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.29,,,102.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.1,,,109.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.53,,,88.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.25,,,88.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.56,,,104.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.69,,,57.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.97,,,102.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.29,,,107.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.69,,,55.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.65,109.1,
"HC QUIKCLOT CLOTTING GAUZE 3""X 24"" 1 STRIP",Sx005020-0025,CDM,,,270,RC,,,,BOTH,,,113.7,101.9,108.02,,,102.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,88.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.33,,,94.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.33,,,57.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.33,,,94.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.71,,,57.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.33,,,102.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.15,,,109.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.57,,,88.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.27,,,88.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.6,,,104.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.71,,,57.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.65,,,96.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.02,,,102.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.33,,,108.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.71,,,55.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.69,109.15,
HC MATTRESS OVERLAY FOAM 73L x 32W x 3H in.,Sx000FP-OVER3,CDM,,,270,RC,,,,BOTH,,,113.99,59.72,108.29,,,59.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.91,,,51.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.59,,,55.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.59,,,33.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.59,,,55.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,33.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.59,,,59.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.43,,,63.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.78,,,51.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.41,,,51.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.87,,,61.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,33.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.89,,,56.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.29,,,59.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.59,,,63.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,55.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.91,109.43,
HC EVIDENCE KIT WA,Px00008441WNH,CDM,,,270,RC,,,,BOTH,,,114,102.6,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,58.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,109.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.42,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.88,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,108.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,55.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.92,109.44,
HC K-WIRE 1.25X150MM SS,Sx00000390157,CDM,,,270,RC,,,,BOTH,,,114,102.6,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,58.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,109.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.42,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.88,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,108.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,55.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.92,109.44,
HC XR FOOT 2 VIEWS,Px00032010110,CDM,73620,CPT,320,RC,,,,BOTH,,,114,102.6,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.92,,,88.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,58.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,94.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,109.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.42,,,88.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.88,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,58.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.9,,,96.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.3,,,102.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.6,,,108.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,55.86,,,55.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,88.92,109.44,
NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%,Rx64980044801,CDM,,,250,RC,64980-0448-01,NDC,,BOTH,1,ML,114.17,102.75,108.46,,,108.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,89.05,,,89.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,102.75,,,102.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,102.75,,,102.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,102.75,,,102.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.94,,,55.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.75,,,102.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,109.6,,,109.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,83.91,,,83.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.5,,,56.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.04,,,105.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.94,,,55.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.04,,,97.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,108.46,,,108.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,102.75,,,102.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,55.94,,,55.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.05,109.6,
HC ASSAY OF CHROMIUM,Px00030112254,CDM,82495,CPT,300,RC,,,,BOTH,,,114.38,102.94,108.66,,,102.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.22,,,89.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,95.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,58.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,95.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.05,,,58.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,102.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.07,,,89.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.61,,,89.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.23,,,105.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.05,,,58.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.22,,,97.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.66,,,102.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,108.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.05,,,56.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.22,109.8,
HC MEPILEX 8X8 ANTI-MICROB FOAM DRESSING,Sx00000287400,CDM,,,270,RC,,,,BOTH,,,114.62,103.16,108.89,,,103.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.4,,,89.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.16,,,95.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.16,,,58.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.16,,,95.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,58.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.16,,,103.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.04,,,110.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,89.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.73,,,89.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.45,,,105.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,58.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.43,,,97.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.89,,,103.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.16,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.16,,,56.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.4,110.04,
AMIODARONE HCL IN DEXTROSE 4.14% IV SOLN 360 MG/200ML,Rx43066036020,CDM,J0282,HCPCS,636,RC,43066036020,NDC,,BOTH,200,ML,114.75,99.63,109.01,,,99.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.51,,,86.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.28,,,92.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.28,,,56.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.28,,,92.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.23,,,56.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.28,,,99.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.16,,,106.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.34,,,86.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.23,,,86.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.57,,,101.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.23,,,56.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.54,,,94.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.01,,,99.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.28,,,105.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.23,,,56.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.51,110.16,
HC IV HYDRATION EACH ADDL HR,Px00026010008,CDM,96361,CPT,761,RC,,,,BOTH,,,115,84.6,109.25,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,73.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,47.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,78.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,90.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,73.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,86.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,47.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,79.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,84.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,89.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
HC INJ IV PUSH SEQUENTIAL NEW DRUG,Px00094010208,CDM,96375,CPT,761,RC,,,,BOTH,,,115,103.5,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,89.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,58.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
HC DRUG SCREEN QUANTALCOHOLS,Px00030110635,CDM,80320,CPT,300,RC,,,,BOTH,,,115,103.5,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,89.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,58.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.91,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
HC DRUG SCREEN QUANTITATIVE ALCOHOLS #,Px00030100837,CDM,80320,CPT,300,RC,,,,BOTH,,,115,103.5,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,89.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,58.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.91,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
HC ASSAY OF GAMMAGLOBULIN IGE (RL),Px00031900011,CDM,82785,CPT,300,RC,,,,BOTH,,,115,103.5,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,89.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,58.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.91,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
"HC GAIT TRAINING THERAPY, EA 15 MIN",Px00042010142,CDM,97116,CPT,420,RC,,,,BOTH,,,115,103.5,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.7,,,89.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,58.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,95.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.53,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.91,,,89.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.8,,,105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,58.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.75,,,97.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.25,,,103.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.5,,,109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.35,,,56.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.7,110.4,
HC NEUTRAPHASE,Px00011797WNH,CDM,,,270,RC,,,,BOTH,,,115.02,103.52,109.27,,,103.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.72,,,89.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.52,,,95.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.52,,,58.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.52,,,95.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.36,,,58.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.52,,,103.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.42,,,110.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.54,,,89.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.92,,,89.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.82,,,105.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.36,,,58.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.77,,,97.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,103.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.52,,,109.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.36,,,56.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.72,110.42,
HC BRACE ANKLE RIGHT - MEDIUM,Px00001002WNH,CDM,L4350,CPT,274,RC,,,,BOTH,,,115.2,103.68,109.44,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.86,,,89.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,95.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,58.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,95.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.45,,,58.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.59,,,110.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.67,,,89.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.01,,,89.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.98,,,105.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.45,,,58.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,97.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,103.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.68,,,109.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.45,,,56.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,89.86,110.59,
HC SAW BLADE 5023-163 MICRO OS 10.0 X 18.5 X 0.4MM,Sx0005023-163,CDM,,,270,RC,,,,BOTH,,,115.44,103.9,109.67,,,103.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,90.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.9,,,96.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.9,,,58.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.9,,,96.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.57,,,58.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.9,,,103.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.82,,,110.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.85,,,90.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.13,,,90.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.57,,,58.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.12,,,98.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.67,,,103.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.9,,,109.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.57,,,56.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.04,110.82,
PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML,Rx67457064000,CDM,J0780,HCPCS,636,RC,67457064000,NDC,,BOTH,2,ML,115.74,104.17,109.95,,,109.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,90.28,,,90.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.71,,,56.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.11,,,111.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,85.07,,,85.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,56.71,,,56.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.48,,,106.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.71,,,56.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.38,,,98.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,109.95,,,109.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.71,,,56.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.28,111.11,
HC CURETTE 8MM UTERINE SUCTION RIGID TIS-U-TRAP,Sx000000MX448,CDM,,,270,RC,,,,BOTH,,,115.9,104.31,110.11,,,104.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.4,,,90.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,96.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,59.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,96.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,59.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,104.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.26,,,111.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.19,,,90.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.36,,,90.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.63,,,106.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,59.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.52,,,98.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.11,,,104.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,110.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,56.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.4,111.26,
HC CURETTE 10MM UTERINE SUCTION RIGID TIS-U-TRAP,Sx000000MX450,CDM,,,270,RC,,,,BOTH,,,115.9,104.31,110.11,,,104.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.4,,,90.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,96.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,59.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,96.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,59.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,104.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.26,,,111.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.19,,,90.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.36,,,90.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.63,,,106.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,59.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.52,,,98.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.11,,,104.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.31,,,110.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.79,,,56.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.4,111.26,
HC WALKER EQUALIZER X- LG,Px00005240WNH,CDM,,,270,RC,,,,BOTH,,,116,104.4,110.2,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.48,,,90.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,96.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,59.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,96.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,59.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.36,,,111.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,90.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.41,,,90.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.72,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,59.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.6,,,98.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.2,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,110.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,56.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.48,111.36,
HC WALKER EQUALIZER LG,Px00002549WNH,CDM,L1830,CPT,274,RC,,,,BOTH,,,116,104.4,110.2,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.48,,,90.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,96.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,59.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,96.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,59.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.36,,,111.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,90.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.41,,,90.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.72,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,59.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.6,,,98.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.2,,,104.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.4,,,110.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.84,,,56.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.48,111.36,
HC NON-PNEUMATIC WALKING SPLINT,Px00002548WNH,CDM,L4386,CPT,274,RC,,,,BOTH,,,116.2,104.58,110.39,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.64,,,90.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,59.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.55,,,111.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.41,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.51,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.9,,,106.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.77,,,98.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.39,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,110.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,56.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.64,111.55,
HC WALKER EQUALIZER MED PREMIUM,Sx000000W0600,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,116.2,104.58,110.39,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.64,,,90.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,59.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.55,,,111.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.41,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.51,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.9,,,106.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.77,,,98.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.39,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.58,,,110.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.94,,,56.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.64,111.55,
DOXYCYCLINE HYCLATE FOR INJ 100 MG,Rx63323013041,CDM,,,250,RC,63323-0130-41,NDC,,BOTH,100,ME,116.23,104.61,110.42,,,110.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,90.66,,,90.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.61,,,104.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.61,,,104.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.61,,,104.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.95,,,56.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.61,,,104.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.58,,,111.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,85.43,,,85.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,57.52,,,57.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.93,,,106.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.95,,,56.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.8,,,98.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,110.42,,,110.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,104.61,,,104.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,56.95,,,56.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.66,111.58,
DOXYCYCLINE HYCLATE FOR INJ 100 MG,Rx63323013017,CDM,,,250,RC,63323-0130-17,NDC,,BOTH,100,ME,116.23,104.61,110.42,,,104.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.66,,,90.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.61,,,96.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.61,,,59.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.61,,,96.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,59.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.61,,,104.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.58,,,111.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.43,,,90.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.52,,,90.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.93,,,106.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,59.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.8,,,98.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.42,,,104.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.61,,,110.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,56.95,,,56.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,90.66,111.58,
HC PR 01212 ANESTH HIP DISARTICULATION,Px00096310115,CDM,1212,CPT,963,RC,,,,BOTH,,,172,154.8,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.6,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.88,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.8,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.84,111.8,BASE FEE
HC PR 01638 ANESTH SHOULDER REPLACEMENT,Px00096310161,CDM,1638,CPT,963,RC,,,,BOTH,,,172,154.8,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,169.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,177.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,169.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,177.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.6,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.88,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.8,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,32.34,,,32.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.84,111.8,BASE FEE
HC PR 01215 ANESTH REVISE HIP REPAIR,Px00096310117,CDM,1215,CPT,963,RC,,,,BOTH,,,172,154.8,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.5,,,147.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.6,,,170.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.88,,,138.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.84,,,138.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,163.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.7,,,90.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.04,,,151.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.32,,,159.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.8,,,168.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.84,111.8,BASE FEE
HC FOAM VAC LG WHITE 10X15CM,SxM6275034-10,CDM,,,270,RC,,,,BOTH,,,116.68,69.05,110.85,,,105.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.01,,,91.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.01,,,97.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.01,,,59.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.01,,,97.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.17,,,59.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.01,,,105.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.01,,,112.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.76,,,91.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.74,,,91.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.35,,,107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.17,,,59.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.18,,,99.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.85,,,105.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.01,,,110.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.17,,,57.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.01,112.01,
HC CUFF TOURNIQUET DISPOSABLE 30 IN SINGLE BLADDER,Sx60-7075-105,CDM,,,270,RC,,,,BOTH,,,116.88,105.19,111.04,,,105.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.17,,,91.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.19,,,97.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.19,,,59.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.19,,,97.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.27,,,59.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.19,,,105.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.2,,,112.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.91,,,91.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.84,,,91.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.53,,,107.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.27,,,59.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.35,,,99.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.04,,,105.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.19,,,111.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.27,,,57.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.17,112.2,
HC GLASSMAN VISCERA RETAINER - SM,Px00007293WNH,CDM,,,270,RC,,,,BOTH,,,116.95,105.26,111.1,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.22,,,91.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,97.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,59.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,97.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,59.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.27,,,112.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.96,,,91.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.88,,,91.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.59,,,107.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,59.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.41,,,99.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.1,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,111.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,57.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.22,112.27,
HC GLASSMAN VISCERA RETNR RMD3204 6 INX9 IN SM,Sx000HS3204-1,CDM,,,270,RC,,,,BOTH,,,116.95,105.26,111.1,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.22,,,91.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,97.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,59.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,97.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,59.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.27,,,112.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.96,,,91.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.88,,,91.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.59,,,107.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,59.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.41,,,99.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.1,,,105.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.26,,,111.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.31,,,57.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.22,112.27,
HC ALPHA-FETOPROTEIN SERUM #,Px00030100127,CDM,82105,CPT,300,RC,,,,BOTH,,,117,105.3,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.26,,,91.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,59.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.9,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.45,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,111.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,57.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.26,112.32,
HC ALPHA-FETOPROTEIN SERUM #,Px00030100565,CDM,82105,CPT,300,RC,,,,BOTH,,,117,105.3,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.26,,,91.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,59.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.9,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.45,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,111.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,57.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.26,112.32,
HC AFP TUMOR MARKER,Px00030014113,CDM,82105,CPT,300,RC,,,,BOTH,,,117,105.3,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.26,,,91.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,59.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.9,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.45,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,111.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,57.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.26,112.32,
HC PRENATAL-ALPHAFETOPROTEIN,Px00030015745,CDM,82105,CPT,300,RC,,,,BOTH,,,117,105.3,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.26,,,91.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,59.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.9,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.45,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,111.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,57.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.26,112.32,
HC ASSAY OF HOMOCYSTEINE #,Px00030112310,CDM,83090,CPT,300,RC,,,,BOTH,,,117,105.3,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.26,,,91.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,59.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,97.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.9,,,91.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,59.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.45,,,99.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,111.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.33,,,57.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.26,112.32,
HC MEPILEX BORDER AG DRESSING 4X8,Px00013247WNH,CDM,,,270,RC,,,,BOTH,,,117.12,105.41,111.26,,,105.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.35,,,91.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.41,,,97.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.41,,,59.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.41,,,97.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.39,,,59.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.41,,,105.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.44,,,112.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.08,,,91.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.96,,,91.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.75,,,107.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.39,,,59.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.55,,,99.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.26,,,105.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.41,,,111.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.39,,,57.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.35,112.44,
HC IMMUNOASSAY TUMOR OTHER,Px00030010567,CDM,86316,CPT,300,RC,,,,BOTH,,,117.37,105.63,111.5,,,105.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.55,,,91.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.63,,,97.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.63,,,59.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.63,,,97.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.51,,,59.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.63,,,105.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.68,,,112.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.27,,,91.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.09,,,91.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.98,,,107.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.51,,,59.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.76,,,99.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.5,,,105.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.63,,,111.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.51,,,57.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,91.55,112.68,
HC PR ED 29105 LONG ARM SPLINT APPLICATION CDM,Px00098110468,CDM,29105,CPT,981,RC,,,,OUTPATIENT,,,194,174.6,108.64,,,174.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.82,,,151.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,195.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,195.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,45.97,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.43,,,174.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,80.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.97,,,151.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,39.97,,,151.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.58,,,178.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,41.17,,,98.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.58,,,164.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.64,,,174.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.95,,,184.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.97,,,39.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,39.97,112.95,
HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR CDM,Px00045010930,CDM,96361,CPT,450,RC,,,,OUTPATIENT,,,118,84.6,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC ED IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR CDM,Px00045011003,CDM,96366,CPT,450,RC,,,,OUTPATIENT,,,118,84.6,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EACH NEW DRUG CDM,Px00045011012,CDM,96375,CPT,450,RC,,,,OUTPATIENT,,,118,84.6,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,80.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,52.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,85.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,98.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,80.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,94.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,52.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,87.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,92.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,97.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC ASSAY OF TRIIODOTHYRONINE T3 FREE #,Px00030100123,CDM,84481,CPT,300,RC,,,,BOTH,,,118,106.2,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,92.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,60.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,113.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,108.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,100.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,112.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC ASSAY OF TRIIODOTHYRONINE T3 FREE #,Px00030100125,CDM,84481,CPT,300,RC,,,,BOTH,,,118,106.2,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,92.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,60.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,113.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,108.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,100.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,112.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC FREE T-3 ICMA,Px00030014932,CDM,84481,CPT,300,RC,,,,BOTH,,,118,106.2,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.04,,,92.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,60.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,98.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.28,,,113.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.4,,,92.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.56,,,108.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,60.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.3,,,100.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.1,,,106.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.2,,,112.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.82,,,57.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.04,113.28,
HC BRACE ANKLE SM LT AIR STRUP,Sx000000002CL,CDM,L4350,HCPCS,274,RC,,,,BOTH,,,118.08,106.27,112.18,,,106.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.1,,,92.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,98.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,60.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,98.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,60.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,106.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.36,,,113.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.79,,,92.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.44,,,92.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.63,,,108.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,60.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.37,,,100.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.18,,,106.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,112.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,57.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.1,113.36,
HC BRACE ANKLE SM RT AIR STRUP,Sx000000002CR,CDM,L4350,HCPCS,274,RC,,,,BOTH,,,118.08,106.27,112.18,,,106.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.1,,,92.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,98.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,60.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,98.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,60.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,106.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.36,,,113.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.79,,,92.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.44,,,92.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.63,,,108.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,60.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.37,,,100.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.18,,,106.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,112.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,57.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.1,113.36,
HC BRACE ANKLE LARGE LT AIR STRUP,Sx000000002AL,CDM,L4350,HCPCS,274,RC,,,,BOTH,,,118.08,106.27,112.18,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.1,,,137.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,147.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,90.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,147.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,90.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.36,,,169.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.79,,,137.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.44,,,137.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.63,,,162.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,90.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.37,,,150.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.18,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,167.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,57.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.1,113.36,
HC BRACE ANKLE LARGE RT AIR STRUP,Sx000000002AR,CDM,L4350,HCPCS,274,RC,,,,BOTH,,,118.08,106.27,112.18,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.1,,,137.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,147.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,90.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,147.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,90.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.36,,,169.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.79,,,137.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.44,,,137.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.63,,,162.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,90.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.37,,,150.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.18,,,158.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.27,,,167.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.86,,,57.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.1,113.36,
HC PR ED 46600 DIAGNOSTIC ANOSCOPY CDM,Px00098110387,CDM,46600,CPT,981,RC,,,,OUTPATIENT,,,165,148.5,92.4,,,148.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.02,,,128.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.13,,,128.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.13,,,47.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.13,,,128.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.98,,,47.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.34,,,148.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.75,,,55.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,128.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,128.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,151.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.08,,,84.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,140.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.4,,,148.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,156.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.85,,,40.85,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,40.85,113.4,
HC PR ED 12001 REPAIR SUPERFIC WOUND(S)< 2.5CM SLP NK AX EXGEN TRNK EX CDM,Px00098110259,CDM,12001,CPT,981,RC,,,,OUTPATIENT,,,227,204.3,127.12,,,204.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.92,,,177.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.88,,,218.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.88,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.88,,,218.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.39,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.44,,,204.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.85,,,61.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.95,,,177.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,42.95,,,177.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.39,,,208.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.24,,,115.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.39,,,192.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.12,,,204.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,215.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,42.95,,,42.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,42.95,113.4,
HC Polypectomy Snare Rotatable Single-Use,Sx00M00561831,CDM,,,270,RC,,,,BOTH,,,118.23,106.41,112.32,,,106.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.22,,,92.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.41,,,98.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.41,,,60.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.41,,,98.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.93,,,60.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.41,,,106.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.5,,,113.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.9,,,92.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.51,,,92.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.77,,,108.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.93,,,60.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.5,,,100.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,106.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.41,,,112.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,57.93,,,57.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.22,113.5,
BENZOCAINE MOUTH/THROAT AEROSOL 20%,Rx00283067902,CDM,,,250,RC,00283-0679-02,NDC,,BOTH,1,EA,118.37,106.53,112.45,,,106.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.33,,,92.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.53,,,98.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.53,,,60.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.53,,,98.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58,,,60.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.53,,,106.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.64,,,113.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87,,,92.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.58,,,92.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58,,,60.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.61,,,100.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.45,,,106.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.53,,,112.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58,,,58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.33,113.64,
BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT,Rx00186037228,CDM,,,250,RC,00186-0372-28,NDC,,BOTH,1,EA,118.54,106.77,112.61,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.46,,,92.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.69,,,98.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.69,,,60.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.69,,,98.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.08,,,60.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.69,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.8,,,113.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.13,,,92.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.67,,,92.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.06,,,109.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.08,,,60.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.76,,,100.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.61,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.69,,,112.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.08,,,58.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.46,113.8,
BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT,Rx00186037028,CDM,,,250,RC,00186-0370-28,NDC,,BOTH,1,EA,118.55,106.77,112.62,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.47,,,92.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,98.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,60.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,98.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.09,,,60.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.81,,,113.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.13,,,92.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.67,,,92.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.07,,,109.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.09,,,60.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.77,,,100.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,106.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,112.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.09,,,58.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.47,113.81,
HC KIT RAPE EVIDENCE WA WA STATE,Sx00000RE-3WA,CDM,,,270,RC,,,,BOTH,,,118.8,106.92,112.86,,,106.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.66,,,92.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,98.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,60.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,98.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,60.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,106.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.05,,,114.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.32,,,92.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.79,,,92.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.3,,,109.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,60.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.98,,,100.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.86,,,106.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.92,,,112.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.21,,,58.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.66,114.05,
HC CATH IV ANGIO 16X5.25 GRAY,Sx00000382259,CDM,,,270,RC,,,,BOTH,,,118.87,102.87,112.93,,,106.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.72,,,92.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,98.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,60.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,98.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.25,,,60.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,106.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.12,,,114.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.37,,,92.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.83,,,92.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.36,,,109.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.25,,,60.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.04,,,101.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.93,,,106.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,112.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.25,,,58.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.72,114.12,
HC ASSAY OF APOLIPOPROTEIN EACH,Px00030112316,CDM,82172,CPT,300,RC,,,,BOTH,,,118.95,107.06,113,,,107.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.78,,,92.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,99.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,60.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,99.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,60.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,107.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.19,,,114.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.43,,,92.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.87,,,92.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.43,,,109.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,60.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.11,,,101.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113,,,107.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,113,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,58.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.78,114.19,
HC CATH IV ANGIO 14X3.25 ORANGE,Sx00000382268,CDM,,,270,RC,,,,BOTH,,,118.95,107.06,113,,,107.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.78,,,92.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,99.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,60.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,99.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,60.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,107.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.19,,,114.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.43,,,92.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.87,,,92.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.43,,,109.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,60.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.11,,,101.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113,,,107.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.06,,,113.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.29,,,58.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.78,114.19,
HC FERRITIN,Px00030013881,CDM,82728,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC GONADOTROPIN CHORIONIC QUANTITATIVE #,Px00030100126,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC GONADOTROPIN CHORIONIC QUANTITATIVE #,Px00030100129,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC GONADOTROPIN CHORIONIC QUANTITATIVE #,Px00030100137,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC GONADOTROPIN CHORIONIC QUANTITATIVE #,Px00030100670,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE,Px00030015025,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC PRENATAL-HCG QUANTITATIVE,Px00030015747,CDM,84702,CPT,300,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC XR FACIAL BONES <3 VIEWS,Px00032010011,CDM,70140,CPT,320,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC XR CLAVICLE  COMPLETE,Px00032010085,CDM,73000,CPT,320,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC XR HEEL MIN 2 VIEWS,Px00032010088,CDM,73650,CPT,320,RC,,,,BOTH,,,119,107.1,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.82,,,92.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,60.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,99.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.24,,,114.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.47,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.89,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.48,,,109.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,60.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.15,,,101.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.31,,,58.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,92.82,114.24,
HC QUIKCLOT CLOTTING SPONGE 5X5,Px00011020WNH,CDM,,,270,RC,,,,BOTH,,,119.82,107.84,113.83,,,107.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.46,,,93.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.84,,,99.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.84,,,61.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.84,,,99.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.71,,,61.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.84,,,107.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.03,,,115.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.07,,,93.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.3,,,93.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.23,,,110.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.71,,,61.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.85,,,101.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.83,,,107.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.84,,,113.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.71,,,58.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.46,115.03,
HC CATH BARTHOLIN  LATEX WORD CATH BALLOON TIP **CONTAINS LATEX**,Sx00005640-00,CDM,,,270,RC,,,,BOTH,,,119.95,107.96,113.95,,,107.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.56,,,93.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.96,,,99.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.96,,,61.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.96,,,99.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.78,,,61.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.96,,,107.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,115.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.16,,,93.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.36,,,93.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.35,,,110.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.78,,,61.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.96,,,101.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.95,,,107.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.96,,,113.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.78,,,58.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.56,115.15,
HC K WIRE SMOOTH 1.4X100MM,Sx00045-80200,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC K WIRE 1.4 X150MM BLUNT TROCAR,Sx000DSDS1014,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC K WIRE 1.6 65MM,SxWIRE-1.6/06,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC K WIRE 1.6 100MM,SxWIRE-1.6/10,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC GUIDE WIRE TROCAR CR TIP 1.35 MM,Sx0AR-8943-38,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC K-WIRE 1.6X150MM SS,Sx00000390164,CDM,,,270,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC METHYLMALONIC ACID LEVEL,Px00030015460,CDM,83921,CPT,300,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC ANESTHESIA IV GA ADDL 15 MIN CDM,Px00037010065,CDM,,,370,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC ANESTHESIA GEN ADDL 15 MIN CDM,Px00037010072,CDM,,,370,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC ANESTHESIA REGIONAL ADDL 15 MIN CDM,Px00037010111,CDM,,,370,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
HC ANESTHESIA MAC ADDL 15 MIN CDM,Px00037010112,CDM,,,370,RC,,,,BOTH,,,120,108,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.6,,,93.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,61.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,99.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.39,,,93.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.4,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,61.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102,,,102,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114,,,108,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,58.8,,,58.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,93.6,115.2,
"HC PR ED 51705 CHANGE OF BLADDER TUBE, SIMPLE CDM",Px00098110091,CDM,51705,CPT,981,RC,,,,OUTPATIENT,,,209,188.1,117.04,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.99,,,163.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,161.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,58.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,161.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.57,,,58.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.55,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,200.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.93,,,163.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.93,,,163.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.13,,,192.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.46,,,58.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.13,,,177.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.04,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.11,,,198.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.93,,,50.93,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,50.93,116.11,
HC LIPID PANEL #,Px00030100541,CDM,80061,CPT,300,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC LIPID PANEL #,Px00030100542,CDM,80061,CPT,300,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC LIPID PANEL #,Px00030100855,CDM,80061,CPT,300,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC LIPID PANEL #,Px00030100856,CDM,80061,CPT,300,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC LIPID PANEL,Px00030112063,CDM,80061,CPT,300,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC XR TAILBONE MIN 2 VIEWS,Px00032010075,CDM,72220,CPT,320,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC XR SHOULDER COMPLETE MIN 2 VIEWS,Px00032010481,CDM,73030,CPT,320,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HC XR ELBOW 2 VIEWS,Px00032010105,CDM,73070,CPT,320,RC,,,,BOTH,,,121,108.9,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.38,,,94.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,61.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,100.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.16,,,116.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.94,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.88,,,94.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,61.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.85,,,102.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,108.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,114.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.29,,,59.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,94.38,116.16,
HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 250 MG,Rx00009001305,CDM,J1720,HCPCS,636,RC,9001305,NDC,,BOTH,250,ME,121.83,99.48,115.74,,,109.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.03,,,95.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,101.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,62.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,101.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.7,,,62.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,109.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.96,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.55,,,95.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.7,,,95.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.08,,,112.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.7,,,62.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.56,,,103.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.74,,,109.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,115.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.7,,,59.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.03,116.96,
HC XR EYE FOR FOREIGN BODY,Px00032010003,CDM,70030,CPT,320,RC,,,,BOTH,,,122,109.8,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.16,,,95.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,62.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.12,,,117.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.38,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.24,,,112.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.7,,,103.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,115.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,59.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.16,117.12,
HC XR STERNUM MIN 2 VIEWS,Px00032010050,CDM,71120,CPT,320,RC,,,,BOTH,,,122,109.8,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.16,,,95.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,62.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.12,,,117.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.38,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.24,,,112.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.7,,,103.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,115.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,59.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.16,117.12,
HC XR FEMUR 1 VIEW,Px00032010614,CDM,73551,CPT,320,RC,,,,BOTH,,,122,109.8,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.16,,,95.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,62.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,101.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.12,,,117.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.38,,,95.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.24,,,112.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,62.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.7,,,103.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.9,,,109.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.8,,,115.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,59.78,,,59.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.16,117.12,
HC ASSAY OF SEX HORMONE BINDING GLOBULIN (RL),Px00031900012,CDM,84270,CPT,300,RC,,,,BOTH,,,122.55,110.3,116.42,,,110.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.59,,,95.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.3,,,102.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.3,,,62.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.3,,,102.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.05,,,62.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.3,,,110.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.65,,,117.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.07,,,95.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.65,,,95.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.75,,,112.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.05,,,62.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.17,,,104.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.42,,,110.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.3,,,116.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.05,,,60.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.59,117.65,
HC CATH CHOLANGIO 4FR EDSLAB,Sx0000420404F,CDM,,,270,RC,,,,BOTH,,,123.4,111.06,117.23,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.25,,,96.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,102.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,62.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,102.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.46,,,118.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.7,,,96.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.07,,,96.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.53,,,113.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.89,,,104.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.23,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,117.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,60.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.25,118.46,
HC CATH CHOLANGIO 6FR EDSLAB,Sx0000420406F,CDM,,,270,RC,,,,BOTH,,,123.4,111.06,117.23,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.25,,,96.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,102.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,62.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,102.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.46,,,118.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.7,,,96.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.07,,,96.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.53,,,113.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,62.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.89,,,104.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.23,,,111.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,117.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.47,,,60.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.25,118.46,
COSYNTROPIN FOR INJ 0.25 MG,Rx00548590000,CDM,J0834,HCPCS,636,RC,548590000,NDC,,BOTH,0.25,ME,123.74,111.45,117.55,,,111.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.52,,,96.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.37,,,103.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.37,,,63.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.37,,,103.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,63.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.37,,,111.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.79,,,118.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.95,,,96.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,96.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.84,,,113.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,63.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.18,,,105.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.55,,,111.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.37,,,117.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.63,,,60.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.52,118.79,
HC HEAVY METAL QUANTIATIVE EACH NES #,Px00030110745,CDM,83018,CPT,300,RC,,,,BOTH,,,123.85,111.47,117.66,,,111.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.6,,,96.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.47,,,103.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.47,,,63.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.47,,,103.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.69,,,63.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.47,,,111.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.9,,,118.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.03,,,96.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.29,,,96.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.94,,,113.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.69,,,63.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.27,,,105.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.66,,,111.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.47,,,117.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.69,,,60.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.6,118.9,
HC AIRWAY LMA CLASSIC NO 2 REUSABLE,Sx00000175020,CDM,,,270,RC,,,,BOTH,,,123.9,111.51,117.71,,,111.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.64,,,96.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.51,,,103.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.51,,,63.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.51,,,103.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.71,,,63.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.51,,,111.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.94,,,118.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.07,,,96.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.32,,,96.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.99,,,114,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.71,,,63.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.32,,,105.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.71,,,111.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.51,,,117.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.71,,,60.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.64,118.94,
PHENOBARBITAL SODIUM INJ 65 MG/ML,Rx42494041501,CDM,J2560,HCPCS,636,RC,42494041501,NDC,,BOTH,1,ML,123.95,111.56,117.75,,,117.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,96.68,,,96.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.74,,,60.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.99,,,118.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.1,,,91.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,60.74,,,60.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,114.03,,,114.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.74,,,60.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.36,,,105.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,117.75,,,117.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,60.74,,,60.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.68,118.99,
HC ELP UR-PROTEIN ELP URINE,Px00030014775,CDM,84166,CPT,300,RC,,,,BOTH,,,124,111.6,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.72,,,96.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,63.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.04,,,119.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.37,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.08,,,114.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.4,,,105.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,117.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,60.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.72,119.04,
HC XR NECK SOFT TISSUE,Px00032010031,CDM,70360,CPT,320,RC,,,,BOTH,,,124,111.6,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.72,,,96.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,63.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.04,,,119.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.37,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.08,,,114.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.4,,,105.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,117.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,60.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.72,119.04,
HC XR SPINE THORACOLUMBAR MIN 2 VIEWS,Px00032010062,CDM,72080,CPT,320,RC,,,,BOTH,,,124,111.6,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.72,,,96.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,63.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.04,,,119.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.37,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.08,,,114.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.4,,,105.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,117.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,60.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.72,119.04,
HC XR LEG INFANT MIN 2 VIEWS,Px00032010161,CDM,73592,CPT,320,RC,,,,BOTH,,,124,111.6,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.72,,,96.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,63.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,103.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.04,,,119.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.37,,,96.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.08,,,114.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,63.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.4,,,105.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.8,,,111.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,117.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.76,,,60.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.72,119.04,
HC ASSAY OF RENIN,Px00030113887,CDM,84244,CPT,300,RC,,,,BOTH,,,124.02,111.62,117.82,,,111.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.74,,,96.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.62,,,103.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.62,,,63.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.62,,,103.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.77,,,63.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.62,,,111.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.06,,,119.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.15,,,96.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.38,,,96.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.1,,,114.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.77,,,63.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.42,,,105.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.82,,,111.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.62,,,117.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,60.77,,,60.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,96.74,119.06,
CEFTRIAXONE SODIUM FOR IV SOLN 2 GM AND DEXTROSE 2.22% 50 ML,Rx00264315511,CDM,J0696,HCPCS,636,RC,264315511,NDC,,BOTH,50,ML,124.59,106.07,118.36,,,112.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.18,,,97.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.13,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.13,,,63.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.13,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.05,,,63.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.13,,,112.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.61,,,119.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.57,,,97.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.05,,,97.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.62,,,114.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.05,,,63.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.9,,,105.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.36,,,112.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.13,,,118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.05,,,61.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.18,119.61,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx00781927406,CDM,J0131,HCPCS,636,RC,781927406,NDC,,BOTH,1,ML,124.6,112.14,118.37,,,118.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.19,,,97.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,119.62,,,119.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.58,,,91.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,114.63,,,114.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.91,,,105.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.37,,,118.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.05,,,61.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.19,119.62,
HC PR ED 59414 DELIVER PLACENTA CDM,Px00098110603,CDM,59414,CPT,981,RC,,,,OUTPATIENT,,,218,196.2,122.08,,,196.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.14,,,170.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.25,,,181.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.25,,,111.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.25,,,181.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.46,,,111.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.7,,,196.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.9,,,209.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,170.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,170.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.26,,,200.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.51,,,111.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.26,,,185.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.08,,,196.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,207.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,141.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.27,119.7,
VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION),Rx42023016401,CDM,,,250,RC,42023-0164-01,NDC,,BOTH,1,ML,124.72,112.25,118.48,,,78.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.28,,,67.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.25,,,72.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.25,,,44.265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.25,,,72.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.11,,,44.265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.25,,,78.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.73,,,83.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.67,,,67.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.72,,,67.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.74,,,79.915,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.11,,,44.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.01,,,73.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.48,,,78.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.25,,,82.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.11,,,61.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.28,119.73,
NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY),Rx70003030065,CDM,,,250,RC,70003-0300-65,NDC,,BOTH,0.4,ME,124.73,112.26,118.49,,,118.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.29,,,97.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.26,,,112.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.26,,,112.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.26,,,112.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.12,,,61.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.26,,,112.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,119.74,,,119.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.68,,,91.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.73,,,61.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.12,,,61.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.02,,,106.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.49,,,118.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.26,,,112.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.12,,,61.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.29,119.74,
HC CANISTER PROSPERA 250ML,Sx0000NP-1004,CDM,,,270,RC,,,,BOTH,,,124.75,112.28,118.51,,,112.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.31,,,97.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.28,,,103.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.28,,,63.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.28,,,103.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.13,,,63.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.28,,,112.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.76,,,119.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.69,,,97.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,97.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.77,,,114.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.13,,,63.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.04,,,106.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.51,,,112.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.28,,,118.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.13,,,61.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.31,119.76,
INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML,Rx00002021301,CDM,J1815,HCPCS,636,RC,2021301,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN LISPRO INJ SOLN 100 UNIT/ML,Rx00002751017,CDM,J1815,HCPCS,636,RC,2751017,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
"INSULIN LISPRO INJ SOLN 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)",Rx00002751017,CDM,J1815,HCPCS,636,RC,2751017,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
"INSULIN LISPRO INJ SOLN 100 UNIT/ML,INSULIN LISPRO SOLN CARTRIDGE 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)",Rx00002751017,CDM,J1817,HCPCS,636,RC,2751017,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML,Rx00002821517,CDM,J1815,HCPCS,636,RC,2821517,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30),Rx00002871517,CDM,J1815,HCPCS,636,RC,2871517,NDC,,BOTH,1,ML,125,112.5,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,91.88,,,91.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,118.75,,,118.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30),Rx00002871501,CDM,J1815,HCPCS,636,RC,2871501,NDC,,BOTH,1,ML,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN GLARGINE INJ 100 UNIT/ML,Rx00088222033,CDM,J1815,HCPCS,636,RC,88222033,NDC,,BOTH,1,ML,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML,Rx00169183411,CDM,J1815,HCPCS,636,RC,169183411,NDC,,BOTH,1,ML,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML,Rx00338012612,CDM,J1815,HCPCS,636,RC,338012612,NDC,,BOTH,100,ML,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC CANNULA CRYST THREAD 5.75MM X 7 CM ORANGE,Sx0000AR-6564,CDM,,,270,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC CANNULA TWIST IN 8.2MM X 7CM,Sx0000AR-6530,CDM,,,270,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC CANNULA PARTIALLY THREADED 7MM,Sx0000AR-6567,CDM,,,270,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC NUCLEAR ANTIGEN ANTIBODY - RNP,Px00030211132,CDM,86235,CPT,300,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC SMRNP AUTOANTIBODY,Px00030012126,CDM,86235,CPT,300,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC SMEAR COMPLEX STAIN-TRICHROME/OVA/PARA,Px00030011257,CDM,87209,CPT,300,RC,,,,BOTH,,,125,112.5,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,97.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,63.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,104.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120,,,120,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.86,,,97.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115,,,115,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,63.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.25,,,106.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.75,,,112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.5,,,118.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,61.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.5,120,
HC PR 58301 REMOVAL INTRAUTERINE DEVICE IUD  CDM,Px00097514099,CDM,58301,CPT,975,RC,,,,BOTH,,,262,235.8,146.72,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.76,,,204.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,243.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,243.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.36,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.1,,,94.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,204.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.34,,,241.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.55,,,133.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.34,,,222.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,146.72,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.61,,,248.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,63.64,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,63.64,120.61,
HC PR ED 58301 REMOVE INTRAUTERINE DEVICE CDM,Px00098110808,CDM,58301,CPT,981,RC,,,,OUTPATIENT,,,269,242.1,150.64,,,242.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.76,,,209.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.13,,,248.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.13,,,248.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.19,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.36,,,242.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.95,,,94.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,209.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.33,,,247.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.55,,,137.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.33,,,228.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,150.64,,,242.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.61,,,255.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.64,,,63.64,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,63.64,120.61,
HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,Px00030100119,CDM,84480,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,Px00030100124,CDM,84480,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC IMMUNOFIXATION SERUM,Px00030211078,CDM,86334,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC IMMUNOFIXJ ELECTROPHORESIS SERUM #,Px00030200526,CDM,86334,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC IMMUNOFIXJ ELECTROPHORESIS SERUM #,Px00030010599,CDM,86334,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC IMMUNOFIX E-PHORESIS SERUM - REF LAB,Px00030011867,CDM,86334,CPT,300,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC XR LOWER LEG 2 VIEWS,Px00032010159,CDM,73590,CPT,320,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC WHEELCHAIR MGMT EA 15 MIN,Px00042010165,CDM,97542,CPT,420,RC,,,,BOTH,,,126,113.4,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.28,,,98.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,64.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,104.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.96,,,120.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.36,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,115.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,64.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.1,,,107.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,113.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.4,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,61.74,,,61.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,98.28,120.96,
HC CUFF TOURNIQUET DISPOSABLE 34 IN SINGLE BLADDER,Sx60707510600,CDM,,,270,RC,,,,BOTH,,,127.07,114.36,120.72,,,114.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.11,,,99.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.36,,,105.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.36,,,64.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.36,,,105.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.26,,,64.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.36,,,114.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.99,,,121.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.4,,,99.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.89,,,99.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.9,,,116.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.26,,,64.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.01,,,108.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.72,,,114.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.36,,,120.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.26,,,62.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.11,121.99,
"HC ANGIOCATH 16G X 3.25""",Px00001631WNH,CDM,,,270,RC,,,,BOTH,,,127.2,114.48,120.84,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.22,,,99.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,105.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,64.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,105.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,64.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.11,,,122.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.49,,,99.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.95,,,99.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.02,,,117.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,64.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.12,,,108.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.84,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,120.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,62.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.22,122.11,
HC GUIDE WIRE 1.2X70MM ANCHORAGE,Sx0AGK0212070,CDM,C1769,HCPCS,278,RC,,,,BOTH,,,127.2,114.48,120.84,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.22,,,99.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,105.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,64.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,105.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,64.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.11,,,122.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.49,,,99.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.95,,,99.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.02,,,117.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,64.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.12,,,108.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.84,,,114.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.48,,,120.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.33,,,62.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.22,122.11,
HC PR ED 30901 CONTROL OF NOSEBLEED SIMPLE CDM,Px00098110317,CDM,30901,CPT,981,RC,,,,OUTPATIENT,,,134,120.6,75.04,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.13,,,104.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,153.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.75,,,153.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.45,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.79,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.7,,,77.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.3,,,104.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,54.3,,,104.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.38,,,123.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.93,,,68.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.38,,,113.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.04,,,120.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.4,,,127.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.3,,,54.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,54.3,122.4,
BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),Rx65250013309,CDM,C9290,HCPCS,636,RC,65250013309,NDC,,BOTH,1,ML,127.82,115.04,121.43,,,121.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,99.7,,,99.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,122.71,,,122.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.95,,,93.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117.59,,,117.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,108.65,,,108.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,121.43,,,121.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.7,122.71,
BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),Rx65250013310,CDM,C9290,HCPCS,636,RC,65250013310,NDC,,BOTH,1,ML,127.82,115.04,121.43,,,121.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,99.7,,,99.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,122.71,,,122.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,93.95,,,93.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117.59,,,117.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,108.65,,,108.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,121.43,,,121.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.04,,,115.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.7,122.71,
BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),Rx65250013304,CDM,C9290,HCPCS,636,RC,65250013304,NDC,,BOTH,1,ML,127.82,115.04,121.43,,,114.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.7,,,99.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.04,,,106.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.04,,,64.915,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.04,,,106.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.63,,,64.915,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.04,,,114.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.71,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.95,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.63,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.59,,,117.195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.63,,,64.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.65,,,108.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.43,,,114.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.04,,,121.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.63,,,62.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.7,122.71,
HC PR 29085 APPLY HAND/WRIST CAST,Px00096910800,CDM,29085,CPT,983,RC,,,,BOTH,,,157,141.3,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.4,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,169.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,169.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.6,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.48,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.35,,,91.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.48,,,122.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.48,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,144.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.5,,,80.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,133.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.86,,,149.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.48,,,67.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,67.48,122.86,
HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE #,Px00030100770,CDM,84154,CPT,300,RC,,,,BOTH,,,128,115.2,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.88,,,122.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.35,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.76,,,117.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.8,,,108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,121.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,62.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.84,122.88,
HC PSA FREE,Px00030015809,CDM,84154,CPT,300,RC,,,,BOTH,,,128,115.2,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.88,,,122.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.35,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.76,,,117.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.8,,,108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,121.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,62.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.84,122.88,
HC XR HUMERUS MIN 2 VIEWS,Px00032010102,CDM,73060,CPT,320,RC,,,,BOTH,,,128,115.2,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.88,,,122.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.35,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.76,,,117.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.8,,,108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,121.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,62.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.84,122.88,
HC XR HIPS UNI W PELVIS 1 VIEW,Px00032010608,CDM,73501,CPT,320,RC,,,,BOTH,,,128,115.2,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.84,,,99.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,65.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,106.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.88,,,122.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.35,,,99.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.76,,,117.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,65.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.8,,,108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.6,,,115.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.2,,,121.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,62.72,,,62.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,99.84,122.88,
FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%,Rx00338051913,CDM,,,250,RC,00338-0519-13,NDC,,BOTH,1,EA,128.25,115.43,121.84,,,121.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,100.04,,,100.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.43,,,115.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.43,,,115.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.43,,,115.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.84,,,62.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.43,,,115.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,123.12,,,123.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,94.26,,,94.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,63.47,,,63.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117.99,,,117.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.84,,,62.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,109.01,,,109.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,121.84,,,121.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.43,,,115.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,62.84,,,62.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,100.04,123.12,
HC FSH,Px00030014937,CDM,83001,CPT,300,RC,,,,BOTH,,,129,116.1,122.55,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.62,,,100.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,107.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,65.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,107.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,65.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.84,,,123.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.82,,,100.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.84,,,100.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.68,,,118.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,65.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,109.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.55,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,122.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,63.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,100.62,123.84,
HC LH,Px00030015391,CDM,83002,CPT,300,RC,,,,BOTH,,,129,116.1,122.55,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.62,,,100.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,107.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,65.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,107.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,65.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.84,,,123.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.82,,,100.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.84,,,100.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.68,,,118.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,65.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.65,,,109.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.55,,,116.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.1,,,122.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.21,,,63.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,100.62,123.84,
HC WALKER EQUALIZER LG PREMIUM,Sx000000W0800,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,130,104.58,123.5,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,90.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,59.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,111.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,106.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,98.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,110.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC WALKER EQUALIZER X-LG PREMIUM,Sx000W1000BLK,CDM,L1830,HCPCS,274,RC,,,,BOTH,,,130,104.58,123.5,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,90.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,59.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,96.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,111.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,90.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,106.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,59.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,98.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,104.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,110.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC IRRIGATION IMPLANTED VAD,Px00076110307,CDM,96523,CPT,761,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC TSH,Px00030112660,CDM,84443,CPT,300,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC TSH REFLEX TO FT4,Px00030114208,CDM,84443,CPT,300,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC ASSAY OF THYROID STIMULATING HORMONE TSH #,Px00030100660,CDM,84443,CPT,300,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC ASSAY OF THYROID STIMULATING HORMONE TSH #,Px00030100661,CDM,84443,CPT,300,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC ASSAY OF THYROID STIMULATING HORMONE TSH #,Px00030100662,CDM,84443,CPT,300,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC XR SCAPULA COMPLETE,Px00032010089,CDM,73010,CPT,320,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC XR WRIST 2 VIEWS,Px00032010118,CDM,73100,CPT,320,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
"HC SELF CARE MNGMENT TRAINING, EA 15 MIN",Px00043010008,CDM,97535,CPT,430,RC,,,,BOTH,,,130,117,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,101.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,66.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,108.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,119.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,66.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,123.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,63.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC XR FOOT MIN 3 VIEWS,Px00032010091,CDM,73630,CPT,320,RC,,,,BOTH,,,180,117,123.5,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,91.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,91.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.34,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,91.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.5,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.7,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.4,124.8,
HC MASK FULL FACE DISP - SMALL,Px00008282WNH,CDM,,,270,RC,,,,BOTH,,,130.4,117.36,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.71,,,101.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,66.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.18,,,125.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.84,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.53,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.97,,,119.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.84,,,110.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,123.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.71,125.18,
HC MASK FULL FACE DISP - MEDIUM,Px00008283WNH,CDM,,,270,RC,,,,BOTH,,,130.4,117.36,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.71,,,101.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,66.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.18,,,125.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.84,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.53,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.97,,,119.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.84,,,110.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,123.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.71,125.18,
HC MASK FULL FACE DISP - LARGE,Px00008284WNH,CDM,,,270,RC,,,,BOTH,,,130.4,117.36,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.71,,,101.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,66.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,108.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.18,,,125.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.84,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.53,,,101.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.97,,,119.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,66.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.84,,,110.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.88,,,117.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.36,,,123.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,63.9,,,63.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.71,125.18,
HC MASK FULL FACE DISP S RESPIRONICS EE LEAK1,Sx00001121062,CDM,,,270,RC,,,,BOTH,,,130.85,121.32,124.31,,,117.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.06,,,102.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,66.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,117.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.62,,,125.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.17,,,102.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.76,,,102.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.38,,,120.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.22,,,111.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.31,,,117.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,124.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,64.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.06,125.62,
HC MASK FULL FACE DISP MED RESPIRONICS AF 541 EE LEAK1,Sx00001121063,CDM,,,270,RC,,,,BOTH,,,130.86,117.77,124.32,,,117.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.07,,,102.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,66.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,117.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.63,,,125.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.18,,,102.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.76,,,102.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.39,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.23,,,111.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.32,,,117.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,124.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,64.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.07,125.63,
HC MASK FULL FACE DISP LARGE RESPIRONICS AF 541 EE LEAK1,Sx00001121064,CDM,,,270,RC,,,,BOTH,,,130.86,121.3,124.32,,,117.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.07,,,102.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,66.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,108.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,117.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.63,,,125.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.18,,,102.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.76,,,102.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.39,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,66.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.23,,,111.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.32,,,117.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.77,,,124.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.12,,,64.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.07,125.63,
HC GLASSMAN VISCERA RETAINER LG 6-3/8 IN X 9-5/8,Sx000HS3206-1,CDM,,,270,RC,,,,BOTH,,,130.97,117.87,124.42,,,117.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.16,,,102.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.87,,,109.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.87,,,66.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.87,,,109.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.18,,,66.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.87,,,117.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.73,,,125.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.26,,,102.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.82,,,102.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.49,,,120.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.18,,,66.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.32,,,111.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.42,,,117.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.87,,,124.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.18,,,64.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.16,125.73,
HC XR SINUSES PARANASAL <3 VIEWS,Px00032010018,CDM,70210,CPT,320,RC,,,,BOTH,,,131,117.9,124.45,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.18,,,102.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,66.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.76,,,125.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.29,,,102.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.83,,,102.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.52,,,120.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.35,,,111.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.45,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,124.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,64.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.18,125.76,
"HC MANUAL THERAPY, EA 15 MIN",Px00042010150,CDM,97140,CPT,420,RC,,,,BOTH,,,131,96.3,124.45,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.18,,,102.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,66.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.76,,,125.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.29,,,102.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.83,,,102.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.52,,,120.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.35,,,111.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.45,,,117.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,124.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,64.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.18,125.76,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML,Rx00075801601,CDM,J1650,HCPCS,636,RC,75801601,NDC,,BOTH,0.6,ML,131,117.9,124.45,,,117.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.18,,,102.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,66.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,109.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,117.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.76,,,125.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.29,,,102.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,102.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.52,,,120.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,66.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.35,,,111.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.45,,,117.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,124.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.19,,,64.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.18,125.76,
HC PR ED 11730 REMOVAL OF NAIL PLATE CDM,Px00098110251,CDM,11730,CPT,981,RC,,,,OUTPATIENT,,,277,249.3,155.12,,,249.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.55,,,216.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.13,,,253.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.13,,,253.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.29,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.92,,,249.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.35,,,69.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,216.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,216.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.89,,,254.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54,,,141.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.89,,,235.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155.12,,,249.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126,,,263.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.43,,,52.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,52.43,126,
HC CANNULA TWIST-IN 7MM X 7 CM,Sx0000AR-6570,CDM,,,270,RC,,,,BOTH,,,131.25,118.13,124.69,,,118.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.38,,,102.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,109.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,66.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,109.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,66.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,118.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.47,,,102.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.96,,,102.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.75,,,120.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,66.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.56,,,111.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.69,,,118.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,124.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.31,,,64.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.38,126,
HC MASK FULL FACE DISP X LARGE,Px00012094WNH,CDM,,,270,RC,,,,BOTH,,,131.8,118.62,125.21,,,118.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.8,,,102.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.62,,,109.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.62,,,67.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.62,,,109.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.58,,,67.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.62,,,118.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.53,,,126.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.87,,,102.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.23,,,102.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.26,,,121.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.58,,,67.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.03,,,112.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.21,,,118.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.62,,,125.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.58,,,64.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.8,126.53,
HC CEA-CARCINOEMBRYONIC ANTIGEN,Px00030014520,CDM,82378,CPT,300,RC,,,,BOTH,,,132,118.8,125.4,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,102.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,109.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,67.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,109.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.72,,,126.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.02,,,102.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.33,,,102.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.44,,,121.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.2,,,112.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.4,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,125.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,64.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.96,126.72,
HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT #,Px00031010500,CDM,88313,CPT,300,RC,,,,BOTH,,,132,118.8,125.4,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,102.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,109.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,67.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,109.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.72,,,126.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.02,,,102.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.33,,,102.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.44,,,121.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,67.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.2,,,112.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.4,,,118.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.8,,,125.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.68,,,64.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,102.96,126.72,
HC MASK FULL FACE DISP X LARGE RESPIRONICS AF541 EE LEAK 1,Sx00001121065,CDM,,,270,RC,,,,BOTH,,,132.3,119.07,125.69,,,119.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.19,,,103.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,110.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,67.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,110.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.83,,,67.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,119.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.01,,,127.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.24,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.48,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.72,,,121.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.83,,,67.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,112.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.69,,,119.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,125.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.83,,,64.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.19,127.01,
HC GUIDE PIN,Sx00000050017,CDM,,,270,RC,,,,BOTH,,,132.63,119.37,126,,,119.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.45,,,103.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.37,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.37,,,67.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.37,,,110.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.99,,,67.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.37,,,119.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.32,,,127.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.48,,,103.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.64,,,103.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.02,,,122.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.99,,,67.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.74,,,112.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,119.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.37,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,64.99,,,64.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.45,127.32,
HC PR ED 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM,Px00098110830,CDM,69200,CPT,981,RC,,,,OUTPATIENT,,,198,178.2,110.88,,,178.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.45,,,154.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.75,,,198.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.75,,,198.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.71,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.9,,,178.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.9,,,79.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,154.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,154.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.86,,,182.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,48.1,,,100.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.86,,,168.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.88,,,178.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.35,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.7,,,46.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,46.7,127.35,
HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,Px00046010026,CDM,94200,CPT,460,RC,,,,BOTH,,,133,119.7,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,67.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.68,,,127.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.36,,,122.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,126.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,65.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.74,127.68,
HC RHYTHM ECG TRACING ONLY,Px00073010003,CDM,93041,CPT,730,RC,,,,BOTH,,,133,119.7,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,67.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.68,,,127.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.36,,,122.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,126.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,65.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.74,127.68,
HC EXTERNAL ECG REC>48HR<7D RECORDING CDM,Px00073100003,CDM,93242,CPT,731,RC,,,,BOTH,,,133,119.7,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,67.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.68,,,127.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.36,,,122.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,126.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,65.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.74,127.68,
HC EXTERNAL ECG REC>7D<15D RECORDING CDM,Px00073100001,CDM,93246,CPT,731,RC,,,,BOTH,,,133,119.7,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,67.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.68,,,127.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.36,,,122.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,126.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,65.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.74,127.68,
HC ISLET CELL ANTIBODY,Px00030010623,CDM,86341,CPT,300,RC,,,,BOTH,,,133,119.7,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.74,,,103.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,67.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,110.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.68,,,127.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.76,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.82,,,103.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.36,,,122.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,67.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.05,,,113.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.35,,,119.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.7,,,126.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,65.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,103.74,127.68,
"HC NEUROMUSCULAR REEDUCATION, EA 15 MIN",Px00042010139,CDM,97112,CPT,420,RC,,,,BOTH,,,134,120.6,127.3,,,120.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.52,,,104.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.6,,,111.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.6,,,68.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.6,,,111.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.66,,,68.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.6,,,120.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.64,,,128.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.49,,,104.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.32,,,104.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.28,,,123.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.66,,,68.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.9,,,113.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.3,,,120.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.6,,,127.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.66,,,65.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.52,128.64,
HC IMMOB AIRCAST ARM MED WITH PILLOW,Sx00000006GMA,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,134.2,120.78,127.49,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.68,,,104.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,111.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,68.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,111.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,68.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.83,,,128.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.64,,,104.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,104.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.46,,,123.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,68.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.07,,,114.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.49,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,127.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,65.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.68,128.83,
HC IMMOB AIRCAST ARM LARGE WITH PILLOW,Sx00000006GLA,CDM,L3650,HCPCS,274,RC,,,,BOTH,,,134.2,120.78,127.49,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.68,,,104.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,111.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,68.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,111.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,68.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.83,,,128.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.64,,,104.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,104.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.46,,,123.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,68.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.07,,,114.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.49,,,120.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.78,,,127.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.76,,,65.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.68,128.83,
PHENOBARBITAL SODIUM INJ 130 MG/ML,Rx54288013710,CDM,J2560,HCPCS,636,RC,54288013710,NDC,,BOTH,1,ML,134.45,121.01,127.73,,,122.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.87,,,106.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.01,,,113.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.01,,,69.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.01,,,113.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.88,,,69.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.01,,,122.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.07,,,130.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.82,,,106.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.88,,,106.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,125.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.88,,,69.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.28,,,115.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.73,,,122.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.01,,,129.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,65.88,,,65.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,104.87,129.07,
HC PR 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV  CDM,Px00097514106,CDM,64405,CPT,975,RC,,,,BOTH,,,178,160.2,99.68,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.17,,,138.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,184.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,184.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.42,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.54,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.9,,,85.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.8,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.8,,,138.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.46,,,163.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.32,,,90.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.46,,,151.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.68,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,169.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.8,,,50.8,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,50.8,129.6,
HC LO-PRO SCREW TM SS 2.7X18MM CORTEX,Sx0AR-8827-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC PROLACTIN,Px00030112073,CDM,84146,CPT,300,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC ANTIBODY HERPES SMPLX TYPE 2 #,Px00030200552,CDM,86696,CPT,300,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG,Px00030010906,CDM,86696,CPT,300,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC XR ANKLE 2 VIEWS,Px00032010163,CDM,73600,CPT,320,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC XR TOE(S) MIN 2 VIEWS,Px00032010004,CDM,73660,CPT,320,RC,,,,BOTH,,,135,121.5,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.3,,,105.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,68.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,112.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,66.81,,,105.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,68.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.75,,,114.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.25,,,121.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.5,,,128.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.15,,,66.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.3,129.6,
HC DRILL BIT 4.2X180mm AO STERILE,Sx01806-4270S,CDM,,,270,RC,,,,BOTH,,,135.55,122,128.77,,,122,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.73,,,105.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122,,,112.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122,,,69.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122,,,112.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,69.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122,,,122,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.13,,,130.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.63,,,105.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.08,,,105.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,124.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,69.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.22,,,115.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.77,,,122,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122,,,128.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,66.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,105.73,130.13,
HC GUIDE WIRE .045mm W/TROCAR TIP THREADED,Sx0AR-8737-42,CDM,,,270,RC,,,,BOTH,,,136.5,122.85,129.68,,,122.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.47,,,106.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,113.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,69.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,113.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.89,,,69.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,122.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.04,,,131.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.33,,,106.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.55,,,106.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.58,,,125.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.89,,,69.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.03,,,116.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.68,,,122.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,129.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,66.89,,,66.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.47,131.04,
HC CUFF TOURNIQUET DISPOSABLE 42 IN SINGLE BLADDER,Sx60707510700,CDM,,,270,RC,,,,BOTH,,,136.77,123.09,129.93,,,123.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.68,,,106.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.09,,,113.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.09,,,69.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.09,,,113.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.02,,,69.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.09,,,123.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.3,,,131.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.53,,,106.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.69,,,106.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.83,,,125.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.02,,,69.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.25,,,116.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.93,,,123.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.09,,,129.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.02,,,67.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.68,131.3,
HC LACTOFERRIN FECAL QUANTITATIVE #,Px00030110181,CDM,83631,CPT,300,RC,,,,BOTH,,,137,123.3,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.86,,,106.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,69.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.52,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.8,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.04,,,126.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.45,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,130.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,67.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.86,131.52,
HC CALPROTECTIN FECAL,Px00030013774,CDM,83993,CPT,300,RC,,,,BOTH,,,137,123.3,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.86,,,106.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,69.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.52,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.8,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.04,,,126.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.45,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,130.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,67.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.86,131.52,
HC XR SPINE CERVICAL 2 OR 3 VIEWS,Px00032010055,CDM,72040,CPT,320,RC,,,,BOTH,,,137,123.3,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.86,,,106.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,69.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.52,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.8,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.04,,,126.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.45,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,130.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,67.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.86,131.52,
HC XR HAND MIN 3 VIEWS,Px00032010129,CDM,73130,CPT,320,RC,,,,BOTH,,,137,123.3,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.86,,,106.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,69.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,114.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.52,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.7,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.8,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.04,,,126.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,69.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.45,,,116.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.15,,,123.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.3,,,130.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.13,,,67.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,106.86,131.52,
HC TRAY SPINAL IT2450 25G WHIT BUPIVACAINE-DEXTROSE-EPI,Sx00000405671,CDM,,,270,RC,,,,BOTH,,,137.36,123.62,130.49,,,123.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.14,,,107.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.62,,,114.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.62,,,70,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.62,,,114.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,70,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.62,,,123.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.87,,,131.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.96,,,107.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,67.98,,,107.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.37,,,126.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,70,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.76,,,116.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.49,,,123.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.62,,,130.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,67.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,107.14,131.87,
HC VITAMIN-B12,Px00030016196,CDM,82607,CPT,300,RC,,,,BOTH,,,138,124.2,131.1,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,114.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,70.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,114.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,70.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.48,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,107.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.3,,,107.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.96,,,126.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,70.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.3,,,117.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.1,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,131.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,67.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,107.64,132.48,
HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,Px00030200088,CDM,86850,CPT,300,RC,,,,BOTH,,,138,120.6,131.1,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.64,,,107.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,114.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,70.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,114.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,70.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.48,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,107.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.3,,,107.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.96,,,126.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,70.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.3,,,117.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.1,,,124.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.2,,,131.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.62,,,67.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,107.64,132.48,
FIDAXOMICIN TAB 200 MG,Rx52015008001,CDM,,,250,RC,52015-0080-01,NDC,,BOTH,200,ME,138.7,117.97,131.77,,,124.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.19,,,108.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,115.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,70.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,115.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.96,,,70.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,124.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.94,,,108.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.64,,,108.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.6,,,127.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.96,,,70.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,117.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.77,,,124.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,131.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,67.96,,,67.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,108.19,133.15,
HC BRACE ANKLE ROYCE SLIM FIT,Px00032300WNH,CDM,L1906,CPT,274,RC,,,,BOTH,,,139,125.1,132.05,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.42,,,108.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,115.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,70.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,115.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,70.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.44,,,133.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.17,,,108.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.79,,,108.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.88,,,127.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,70.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.15,,,118.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.05,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,132.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,68.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,108.42,133.44,
HC XR ELBOW COMPLETE MIN 3 VIEWS,Px00032010106,CDM,73080,CPT,320,RC,,,,BOTH,,,139,125.1,132.05,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.42,,,108.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,115.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,70.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,115.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,70.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.44,,,133.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.17,,,108.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,68.79,,,108.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.88,,,127.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,70.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.15,,,118.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.05,,,125.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.1,,,132.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.11,,,68.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,108.42,133.44,
HC PR ED 64505 INJECTION ANES AGENT SPHENOPALATINE GANGLION CDM,Px00098100006,CDM,64505,CPT,981,RC,,,,OUTPATIENT,,,377,339.3,211.12,,,339.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.57,,,294.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.63,,,313.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.63,,,192.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.63,,,313.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,192.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.6,,,339.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.35,,,361.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.54,,,294.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.54,,,294.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.89,,,346.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.65,,,192.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.89,,,320.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.12,,,339.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,358.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.54,,,103.54,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,103.54,134.1,
HC IODINE SERUM,Px00030013905,CDM,83789,CPT,300,RC,,,,BOTH,,,140,126,133,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.2,,,109.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,116.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,71.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,116.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.6,,,71.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.4,,,134.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,109.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.29,,,109.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.8,,,128.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.6,,,71.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119,,,119,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133,,,126,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126,,,133,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,68.6,,,68.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,109.2,134.4,
HC PR 99460 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,Px00096910630,CDM,99460,CPT,987,RC,,,,BOTH,,,219,197.1,122.64,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.71,,,170.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,182.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,182.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.5,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.36,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.45,,,210.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,170.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,170.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,201.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,186.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.64,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,208.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,28.98,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.98,134.88,
HC PR 10005 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION,Px00097511272,CDM,10005,CPT,975,RC,,,,BOTH,,,324,291.6,181.44,,,291.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.1,,,252.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.5,,,287.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.5,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.5,,,287.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.74,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.82,,,291.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,311.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.21,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.21,,,252.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.68,,,298.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.32,,,165.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.68,,,275.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.44,,,291.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135,,,307.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.21,,,70.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.21,135,
HC PR 59412 EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,Px00097511314,CDM,59412,CPT,975,RC,,,,BOTH,,,246,221.4,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.3,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,204.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,125.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,204.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.86,,,125.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.39,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.3,,,236.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,191.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,226.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.08,,,125.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,209.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135,,,233.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,141.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.27,135,
HC FOLATE,Px00030014898,CDM,82746,CPT,300,RC,,,,BOTH,,,141,126.9,133.95,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.98,,,109.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,117.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,71.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,117.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,71.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.36,,,135.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,109.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.78,,,109.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.72,,,129.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,71.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.85,,,119.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.95,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,133.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,69.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,109.98,135.36,
"HC THERAPEUTIC EXERCISES, EA 15 MIN",Px00042010131,CDM,97110,CPT,420,RC,,,,BOTH,,,141,105.3,133.95,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.98,,,109.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,117.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,71.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,117.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,71.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.36,,,135.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,109.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.78,,,109.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.72,,,129.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,71.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.85,,,119.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.95,,,126.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.9,,,133.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,69.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,109.98,135.36,
HC XR RIBS/CHEST UNI MIN 3 VIEWS,Px00032010046,CDM,71101,CPT,320,RC,,,,BOTH,,,142,127.8,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.76,,,110.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,72.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.32,,,136.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.37,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.28,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.64,,,130.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.7,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,69.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,110.76,136.32,
HC XR SPINE THORACIC 2 VIEWS,Px00032010059,CDM,72070,CPT,320,RC,,,,BOTH,,,142,127.8,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.76,,,110.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,72.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.32,,,136.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.37,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.28,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.64,,,130.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.7,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,69.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,110.76,136.32,
HC XR KNEE 1-2 VIEWS,Px00032010149,CDM,73560,CPT,320,RC,,,,BOTH,,,142,127.8,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.76,,,110.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,72.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.32,,,136.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.37,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.28,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.64,,,130.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.7,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,69.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,110.76,136.32,
HC XR ANKLE COMPLETE MIN 3 VIEWS,Px00032010165,CDM,73610,CPT,320,RC,,,,BOTH,,,142,127.8,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.76,,,110.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,72.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,118.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.32,,,136.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.37,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.28,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.64,,,130.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,72.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.7,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.9,,,127.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.8,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.58,,,69.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,110.76,136.32,
HC BLADE DERMATOME STERILE,Sx00-8800-000,CDM,,,270,RC,,,,BOTH,,,142.75,128.48,135.61,,,128.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.35,,,111.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.48,,,118.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.48,,,72.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.48,,,118.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.95,,,72.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.48,,,128.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.04,,,137.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.92,,,111.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.65,,,111.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.33,,,131.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.95,,,72.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.34,,,121.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.61,,,128.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.48,,,135.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,69.95,,,69.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,111.35,137.04,
HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH #,Px00030210247,CDM,86146,CPT,300,RC,,,,BOTH,,,143,128.7,135.85,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.54,,,111.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,119.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,72.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,119.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,72.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.11,,,111.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.77,,,111.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.56,,,131.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,72.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.55,,,121.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.85,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,135.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,70.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,111.54,137.28,
HC CARDIOLIPIN ANTIBODY EACH IG CLASS #,Px00030210144,CDM,86147,CPT,300,RC,,,,BOTH,,,143,128.7,135.85,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.54,,,111.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,119.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,72.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,119.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,72.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.11,,,111.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.77,,,111.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.56,,,131.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,72.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.55,,,121.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.85,,,128.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.7,,,135.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.07,,,70.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,111.54,137.28,
HC NEEDLE BREAST LESION LOCALIZATION 20GA X 9CM W/SPRING HOOK,Sx00000G02587,CDM,,,270,RC,,,,BOTH,,,143.35,106.81,136.18,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.81,,,111.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.02,,,119.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.02,,,73.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.02,,,119.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.24,,,73.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.02,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.62,,,137.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.36,,,111.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.94,,,111.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.88,,,131.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.24,,,73.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.85,,,121.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.18,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.02,,,136.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.24,,,70.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,111.81,137.62,
HC ASSAY OF ALUMINUM,Px00030112096,CDM,82108,CPT,300,RC,,,,BOTH,,,143.74,129.37,136.55,,,129.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.12,,,112.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.37,,,119.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.37,,,73.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.37,,,119.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.43,,,73.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.37,,,129.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.99,,,137.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.65,,,112.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.14,,,112.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.24,,,132.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.43,,,73.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.18,,,122.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.55,,,129.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.37,,,136.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.43,,,70.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.12,137.99,
LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),Rx25021016987,CDM,J2020,HCPCS,636,RC,25021016987,NDC,,BOTH,300,ML,143.77,129.39,136.58,,,136.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,,,112.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.39,,,129.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.39,,,129.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.39,,,129.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.45,,,70.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,129.39,,,129.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,138.02,,,138.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,105.67,,,105.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.45,,,70.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.27,,,132.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.45,,,70.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,122.2,,,122.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,136.58,,,136.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.39,,,129.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.45,,,70.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.14,138.02,
HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM,Px00098110260,CDM,12002,CPT,981,RC,,,,OUTPATIENT,,,274,246.6,153.44,,,246.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.28,,,213.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.25,,,251.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.25,,,251.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.34,,,246.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,150.7,,,80.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.3,,,213.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,56.3,,,213.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.18,,,252.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.99,,,139.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.18,,,232.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.44,,,246.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,260.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.3,,,56.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,56.3,138.15,
HC XR PELVIS 1-2 VIEWS,Px00032010069,CDM,72170,CPT,320,RC,,,,BOTH,,,144,129.6,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,73.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.24,,,138.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.48,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.4,,,122.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,136.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,70.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.32,138.24,
HC XR FEMUR MIN 2 VIEWS,Px00032010615,CDM,73552,CPT,320,RC,,,,BOTH,,,144,129.6,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,73.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.24,,,138.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.48,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.4,,,122.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,136.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,70.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.32,138.24,
HC EVALUATE SWALLOWING FUNCTION,Px00044410026,CDM,92610,CPT,444,RC,,,,BOTH,,,144,129.6,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.32,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,73.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.24,,,138.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.27,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.48,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.4,,,122.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.8,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.6,,,136.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,70.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.32,138.24,
VERAPAMIL HCL IV SOLN 2.5 MG/ML,Rx51754020404,CDM,J7999,HCPCS,636,RC,51754020404,NDC,,BOTH,5,ML,144.5,130.05,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.71,,,112.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.81,,,70.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,138.72,,,138.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,106.21,,,106.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,70.81,,,70.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.94,,,132.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.81,,,70.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,122.83,,,122.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,70.81,,,70.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.71,138.72,
VERAPAMIL HCL IV SOLN 2.5 MG/ML,Rx51754020401,CDM,J7999,HCPCS,636,RC,51754020401,NDC,,BOTH,1,ML,144.5,130.05,137.28,,,130.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.71,,,112.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,120.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,73.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,120.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.81,,,73.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.72,,,138.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.21,,,112.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.81,,,112.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.94,,,132.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.81,,,73.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.83,,,122.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,130.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,70.81,,,70.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.71,138.72,
HC PR ED 12011 REPAIR SUPERFIC WOUND(S) <2.5 FACE ERS EYLD NSE LPS MUC CDM,Px00098110265,CDM,12011,CPT,981,RC,,,,OUTPATIENT,,,273,245.7,152.88,,,245.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.38,,,212.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.63,,,251.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.63,,,251.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.44,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.22,,,245.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,150.15,,,76.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.43,,,212.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.43,,,212.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155.61,,,251.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.03,,,139.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155.61,,,232.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,245.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.06,,,259.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.43,,,53.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,53.43,139.06,
HC PR ED 56405 I & D OF VULVA/PERINEUM CDM,Px00098110802,CDM,56405,CPT,981,RC,,,,OUTPATIENT,,,343,308.7,192.08,,,308.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,150.91,,,267.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.38,,,300.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.38,,,300.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.74,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.86,,,308.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.65,,,148.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.86,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.86,,,267.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,315.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.64,,,174.79,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,291.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.08,,,308.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.06,,,325.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.86,,,125.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,125.86,139.06,
HC CHEMO IV INFUSION ADDL HR,Px00033510004,CDM,96415,CPT,761,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC PROGESTERONE,Px00030112067,CDM,84144,CPT,300,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC C PEPTIDE,Px00030014462,CDM,84681,CPT,300,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC IMMUNOASSAY TUMOR CA 15-3 27-29,Px00030010554,CDM,86300,CPT,300,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC IMMUNOASSAY TUMOR CA 19-9,Px00030010558,CDM,86301,CPT,300,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC IMMUNOASSAY TUMOR CA 125,Px00030010560,CDM,86304,CPT,300,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
HC XR RIBS UNI 2 VIEWS,Px00032010045,CDM,71100,CPT,320,RC,,,,BOTH,,,145,130.5,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.1,,,113.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,73.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,120.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.2,,,139.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.58,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,71.76,,,113.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.4,,,133.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,73.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.25,,,123.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.75,,,130.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.5,,,137.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.05,,,71.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.1,139.2,
MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED),Rx00085134106,CDM,,,250,RC,00085-1341-06,NDC,,BOTH,0.22,ME,145.24,130.72,137.98,,,137.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,113.29,,,113.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.72,,,130.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.72,,,130.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.72,,,130.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.17,,,71.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.72,,,130.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,139.43,,,139.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,106.75,,,106.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,71.88,,,71.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,133.62,,,133.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.17,,,71.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,123.45,,,123.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,137.98,,,137.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,130.72,,,130.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,71.17,,,71.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.29,139.43,
HC XR SKULL 1-3 VIEWS,Px00032010022,CDM,70250,CPT,320,RC,,,,BOTH,,,146,131.4,138.7,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.88,,,113.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,121.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,74.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,121.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,74.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.16,,,140.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.31,,,113.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.26,,,113.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.32,,,134.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,74.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.1,,,124.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.7,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,138.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,71.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.88,140.16,
HC XR SACROILIAC JOINTS 3+ VIEWS,Px00032010074,CDM,72202,CPT,320,RC,,,,BOTH,,,146,131.4,138.7,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.88,,,113.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,121.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,74.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,121.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,74.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.16,,,140.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.31,,,113.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.26,,,113.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.32,,,134.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,74.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.1,,,124.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.7,,,131.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,138.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.54,,,71.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.88,140.16,
HC PAD SENSA TRAC FREEDOM VAC TUBE CLAMP,SxM8275057/10,CDM,,,270,RC,,,,BOTH,,,146.32,97.96,139,,,131.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.13,,,114.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.69,,,121.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.69,,,74.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.69,,,121.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.7,,,74.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.69,,,131.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.47,,,140.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.55,,,114.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.41,,,114.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.61,,,134.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.7,,,74.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.37,,,124.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139,,,131.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.69,,,139,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,71.7,,,71.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,114.13,140.47,
NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,Rx67457083902,CDM,,,250,RC,67457-0839-02,NDC,,BOTH,1,ML,146.94,132.37,139.59,,,132.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.61,,,114.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.25,,,122.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.25,,,74.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.25,,,122.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,74.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.25,,,132.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.06,,,141.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108,,,114.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,72.72,,,114.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.18,,,135.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,74.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.9,,,124.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.59,,,132.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.25,,,139.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72,,,72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,114.61,141.06,
NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,Rx71288020202,CDM,,,250,RC,71288-0202-02,NDC,,BOTH,1,ML,147.48,89.96,140.11,,,140.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.03,,,115.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.27,,,72.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,141.58,,,141.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,108.4,,,108.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,72.99,,,72.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.68,,,135.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.27,,,72.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,125.36,,,125.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.11,,,140.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.27,,,72.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.03,141.58,
HC CANCELLOUS SCREW FULL THREAD 4.0MM X 46MM TI,Sx00000607346,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,147.9,133.11,140.51,,,133.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.36,,,115.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.11,,,123.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.11,,,75.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.11,,,123.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.47,,,75.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.11,,,133.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.98,,,141.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.71,,,115.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.2,,,115.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.07,,,136.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.47,,,75.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.72,,,125.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.51,,,133.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.11,,,140.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.47,,,72.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.36,141.98,
HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL #,Px00030110603,CDM,84153,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL,Px00030015761,CDM,84153,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC PSA ULTRASENSITIVE,Px00030015810,CDM,84153,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC PSA SCREENING,Px00030110064,CDM,84153,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC IGF-1 SERUM,Px00030015218,CDM,84305,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC VITAMIN B-1 LEVEL,Px00030016184,CDM,84425,CPT,300,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC XR SPINE THORACIC 3 VIEWS,Px00032010060,CDM,72072,CPT,320,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS,Px00032010065,CDM,72100,CPT,320,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC XR ABDOMEN 2 VIEWS,Px00032010107,CDM,74019,CPT,320,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
HC XR ABDOMEN 3+ VIEWS,Px00032010135,CDM,74021,CPT,320,RC,,,,BOTH,,,148,133.2,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.44,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,75.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,123.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.08,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.25,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.16,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.8,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.6,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,72.52,,,72.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.44,142.08,
NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,Rx67457099902,CDM,,,250,RC,67457-0999-02,NDC,,BOTH,1,ML,148.09,133.28,140.69,,,140.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,115.51,,,115.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,133.28,,,133.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,133.28,,,133.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,133.28,,,133.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.56,,,72.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,133.28,,,133.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,142.17,,,142.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,108.85,,,108.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,73.29,,,73.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,136.24,,,136.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.56,,,72.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,125.88,,,125.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.69,,,140.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,133.28,,,133.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,72.56,,,72.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,115.51,142.17,
HC PR 31500 INTUBATION W/BRONCHOSCOPE,Px00096310220,CDM,31500,CPT,963,RC,,,,BOTH,,,178,160.2,99.68,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.11,,,138.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,148.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,90.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.25,,,148.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.66,,,90.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.48,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.33,,,170.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.12,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.66,,,138.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.33,,,163.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.55,,,90.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.46,,,151.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.68,,,160.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,169.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.66,,,83.66,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,83.66,142.2,
HC PR 31500 INSERT EMERGENCY ENDOTRACH AIRWAY [31500] CDM,Px00097500051,CDM,31500,CPT,975,RC,,,,BOTH,,,332,298.8,185.92,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.11,,,258.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,276.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,276.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155.81,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.48,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.6,,,318.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,258.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.24,,,305.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.55,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.24,,,282.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.92,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,315.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,247.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,247.3,142.2,
HC PR ED 31500 INS EMERGENCY AIRWAY CDM,Px00098110324,CDM,31500,CPT,981,RC,,,,OUTPATIENT,,,332,298.8,185.92,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.11,,,258.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,276.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.5,,,276.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,284.4,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.48,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.6,,,318.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,258.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.24,,,305.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.72,,,169.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.24,,,282.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.92,,,298.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,315.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.3,,,247.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,247.3,142.2,
HC BLOOD GAS,Px00030014449,CDM,82803,CPT,300,RC,,,,BOTH,,,149,134.1,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.22,,,116.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,75.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.04,,,143.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.52,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.74,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.08,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.65,,,126.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,141.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.22,143.04,
HC XR NASAL BONES MIN 3 VIEWS,Px00032010014,CDM,70160,CPT,320,RC,,,,BOTH,,,149,134.1,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.22,,,116.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,75.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.04,,,143.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.52,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.74,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.08,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.65,,,126.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,141.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.22,143.04,
HC XR RIBS BIL 3 VIEWS,Px00032010048,CDM,71110,CPT,320,RC,,,,BOTH,,,149,134.1,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.22,,,116.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,75.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.04,,,143.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.52,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.74,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.08,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.65,,,126.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,141.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.22,143.04,
HC BONE DENSITY PERIPHERAL SKELETON,Px00032010345,CDM,77081,CPT,320,RC,,,,BOTH,,,149,134.1,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.22,,,116.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,75.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,124.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.04,,,143.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.52,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.74,,,116.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.08,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,75.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.65,,,126.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.55,,,134.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.1,,,141.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.01,,,73.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.22,143.04,
HC INTERPULSE HANDPIECE W/TIP PULSE LAVAGE,Sx00210114000,CDM,,,270,RC,,,,BOTH,,,149.87,134.88,142.38,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.9,,,116.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,124.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,76.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,124.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.44,,,76.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,134.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.88,,,143.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.15,,,116.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.17,,,116.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.88,,,137.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.44,,,76.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.39,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.38,,,134.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.88,,,142.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.44,,,73.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.9,143.88,
METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV),Rx00009075801,CDM,J2930,HCPCS,636,RC,9075801,NDC,,BOTH,500,ME,149.91,135.05,142.41,,,134.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.93,,,116.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.92,,,164.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.92,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.92,,,164.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.46,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.92,,,134.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,143.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.18,,,116.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,73.46,,,116.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,137.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.46,,,76.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.42,,,127.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.41,,,134.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.92,,,142.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.46,,,73.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.93,143.91,
HC FIBERTAPE NO MORE DISCRIPTION WAS PROVID,Sx0000AR-7237,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,150,135,142.5,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,124.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,76.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,124.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.25,,,117,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,117,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138,,,138,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.5,,,127.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,142.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,73.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117,144,
"HC THERAPEUTIC ACTIVITIES, EA 15 MIN",Px00042010160,CDM,97530,CPT,420,RC,,,,BOTH,,,150,135,142.5,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117,,,117,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,124.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,76.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,124.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.25,,,117,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.24,,,117,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138,,,138,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,76.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.5,,,127.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135,,,142.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.5,,,73.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117,144,
HC US OB < 14 WKS ADDL FETUS,Px00040210015,CDM,76802,CPT,402,RC,,,,BOTH,,,151,135.9,143.45,,,135.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.78,,,117.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.9,,,125.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.9,,,76.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.9,,,125.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.99,,,76.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.9,,,135.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.96,,,144.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.99,,,117.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.73,,,117.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138.92,,,138.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.99,,,76.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.35,,,128.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.45,,,135.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.9,,,143.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,73.99,,,73.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117.78,144.96,
HC ASSAY OF CALCITONIN,Px00030112049,CDM,82308,CPT,300,RC,,,,BOTH,,,151.1,135.99,143.55,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.86,,,117.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.99,,,125.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.99,,,77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.99,,,125.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.04,,,77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.99,,,135.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.06,,,145.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.06,,,117.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,117.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.01,,,139.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.04,,,77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.44,,,128.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.55,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.99,,,143.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.04,,,74.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,117.86,145.06,
HC PR 99233 SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES CDM,Px00098710013,CDM,99233,CPT,987,RC,,,,BOTH,,,237,213.3,132.72,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,184.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,197.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.13,,,197.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.73,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.32,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.35,,,227.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,184.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,184.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.09,,,218.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.99,,,120.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.09,,,201.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.72,,,213.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.13,,,225.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,145.13,
HC PR ED 12013 REPAIR SUPERFIC WOUND(S) 2.6 TO 5.0CM FACE ERS EYLD NSE CDM,Px00098110266,CDM,12013,CPT,981,RC,,,,OUTPATIENT,,,138,124.2,77.28,,,124.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.95,,,107.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.25,,,114.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.25,,,70.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.25,,,114.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.32,,,70.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.36,,,124.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.9,,,132.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.06,,,107.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.06,,,107.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.66,,,126.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,56.71,,,70.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.66,,,117.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.28,,,124.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,131.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.06,,,55.06,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,55.06,145.35,
HC IV INFUSION SEQUENTIAL HR,Px00026010011,CDM,96367,CPT,761,RC,,,,BOTH,,,153,137.7,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.34,,,119.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,77.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.88,,,146.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.76,,,140.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,74.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.34,146.88,
HC HEREDITARY HEMOCHROMATOSIS GENE ANALYSIS,Px00030010279,CDM,81256,CPT,300,RC,,,,BOTH,,,153,137.7,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.34,,,119.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,77.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.88,,,146.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.72,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.76,,,140.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,74.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.34,146.88,
HC RENIN ACTIVITY,Px00030015879,CDM,84244,CPT,300,RC,,,,BOTH,,,153,137.7,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.34,,,119.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,77.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.88,,,146.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.72,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.76,,,140.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,74.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.34,146.88,
HC XR FINGERS(S) MIN 2 VIEWS,Px00032010131,CDM,73140,CPT,320,RC,,,,BOTH,,,153,137.7,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.34,,,119.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,77.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.88,,,146.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.46,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.72,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.76,,,140.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.7,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,74.97,,,74.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.34,146.88,
HC ASSAY OF PROGESTERONE,Px00030112092,CDM,83498,CPT,300,RC,,,,BOTH,,,153.24,137.92,145.58,,,137.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.53,,,119.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,127.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,78.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,127.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,78.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,137.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.11,,,147.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.63,,,119.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.84,,,119.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.98,,,140.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,78.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.25,,,130.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.58,,,137.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,145.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.09,,,75.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.53,147.11,
HC EPISTAXIS PACKING NASAL,Px00000923WNH,CDM,,,270,RC,,,,BOTH,,,153.5,138.15,145.83,,,138.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.73,,,119.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,127.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,78.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,127.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.22,,,78.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,138.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.36,,,147.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.82,,,119.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.97,,,119.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.22,,,141.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.22,,,78.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.48,,,130.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.83,,,138.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.15,,,145.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.22,,,75.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,119.73,147.36,
HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<  CDM,Px00097513996,CDM,11042,CPT,983,RC,,,,BOTH,,,141,126.9,78.96,,,126.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.4,,,109.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.13,,,158,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.13,,,158,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.02,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.76,,,126.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.55,,,83.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,109.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,109.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.37,,,129.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.92,,,71.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.37,,,119.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.96,,,126.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.49,,,133.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,59.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,59.15,148.49,
HC PR 11042 DEB SUBQ TISSUE 20 SQ CM/<,Px00098310221,CDM,11042,CPT,975,RC,,,,BOTH,,,311,279.9,174.16,,,279.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.4,,,242.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.38,,,277.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.38,,,277.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.02,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.76,,,279.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.05,,,83.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,242.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,242.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.27,,,286.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,60.92,,,158.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.27,,,264.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.16,,,279.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.49,,,295.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.15,,,59.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,59.15,148.49,
HC AVLARADO DISPOSABLE LINER,Sx00132001510,CDM,,,270,RC,,,,BOTH,,,154.96,139.46,147.21,,,139.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.87,,,120.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.46,,,129,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.46,,,78.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.46,,,129,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.93,,,78.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.46,,,139.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.76,,,148.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.9,,,120.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.69,,,120.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.56,,,142.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.93,,,78.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.72,,,131.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.21,,,139.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.46,,,147.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.93,,,75.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.87,148.76,
HC DIHYDROTESTOSTERONE (DHT) #,Px00030110364,CDM,82642,CPT,300,RC,,,,BOTH,,,155,139.5,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.9,,,120.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,78.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.8,,,148.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.71,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.6,,,142.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.75,,,131.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,147.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,75.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.9,148.8,
HC XR SINUSES PARANASAL MIN 3 VIEWS,Px00032010020,CDM,70220,CPT,320,RC,,,,BOTH,,,155,139.5,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.9,,,120.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,78.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.8,,,148.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.71,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.6,,,142.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.75,,,131.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,147.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,75.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.9,148.8,
HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS,Px00032010051,CDM,71130,CPT,320,RC,,,,BOTH,,,155,139.5,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.9,,,120.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,78.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.8,,,148.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.71,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.6,,,142.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.75,,,131.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,147.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,75.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.9,148.8,
HC US EXAM PELVIC LIMITED,Px00040210009,CDM,76857,CPT,402,RC,,,,BOTH,,,155,139.5,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.9,,,120.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,78.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.8,,,148.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.71,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.6,,,142.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.75,,,131.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,147.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,75.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.9,148.8,
HC SPEECH/HEARING THERAPY - INDIV,Px00044010016,CDM,92507,CPT,440,RC,,,,BOTH,,,155,139.5,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.9,,,120.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,78.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,129.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.8,,,148.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,76.71,,,120.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.6,,,142.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,78.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.75,,,131.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.25,,,139.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.5,,,147.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,75.95,,,75.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,120.9,148.8,
HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM,Px00098110229,CDM,10060,CPT,981,RC,,,,OUTPATIENT,,,293,263.7,164.08,,,263.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.47,,,228.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.13,,,265.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.13,,,265.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.71,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.08,,,263.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.15,,,129.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,228.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,228.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.01,,,269.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.9,,,149.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.01,,,249.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,164.08,,,263.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,278.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.7,,,106.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,106.7,149.4,
LEVOFLOXACIN IV SOLN 25 MG/ML,Rx17478010730,CDM,J1956,HCPCS,636,RC,17478010730,NDC,,BOTH,1,ML,156.12,140.51,148.31,,,148.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,121.77,,,121.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.51,,,140.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.51,,,140.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.51,,,140.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.5,,,76.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.51,,,140.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,149.88,,,149.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,114.75,,,114.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.5,,,76.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.63,,,143.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.5,,,76.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.7,,,132.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,148.31,,,148.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.51,,,140.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.5,,,76.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,121.77,149.88,
ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT),Rx00049120301,CDM,J3486,HCPCS,636,RC,49120301,NDC,,BOTH,20,ME,156.15,140.54,148.34,,,148.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,121.8,,,121.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.54,,,140.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.54,,,140.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.54,,,140.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.51,,,76.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.54,,,140.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,149.9,,,149.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,114.77,,,114.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,76.51,,,76.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.66,,,143.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.51,,,76.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.73,,,132.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,148.34,,,148.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,140.54,,,140.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,76.51,,,76.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,121.8,149.9,
HC PRE CUT CARTIFORM TEMPLATES,Sx0ABS-1100-T,CDM,,,270,RC,,,,BOTH,,,156.25,140.63,148.44,,,140.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.88,,,121.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.63,,,130.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.63,,,79.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.63,,,130.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.56,,,79.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.63,,,140.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150,,,150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.84,,,121.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.33,,,121.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.75,,,143.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.56,,,79.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.81,,,132.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.44,,,140.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.63,,,148.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,76.56,,,76.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,121.88,150,
HC SYRINGE ASSEMBLY 60MLW/GUAGE INFLATION,Sx0M005506001,CDM,,,270,RC,,,,BOTH,,,157.39,141.65,149.52,,,141.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.76,,,122.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.65,,,131.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.65,,,80.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.65,,,131.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.12,,,80.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.65,,,141.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.09,,,151.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.68,,,122.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.89,,,122.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.8,,,144.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.12,,,80.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.78,,,133.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.52,,,141.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.65,,,149.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.12,,,77.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,122.76,151.09,
HC PR 64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM,Px00096310243,CDM,64415,CPT,963,RC,,,,BOTH,,,147,132.3,82.32,,,132.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.08,,,114.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,123.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,77.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.88,,,123.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,77.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,77.27,,,132.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.83,,,88.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.38,,,114.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,114.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.83,,,135.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.83,,,74.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,124.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,132.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.81,,,57.81,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,69.09,151.2,
HC GUIDE WIRE 2.4mm W/TROCAR TIP THDD,Sx00AR-8770KT,CDM,,,270,RC,,,,BOTH,,,157.5,141.75,149.63,,,141.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.85,,,122.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.75,,,131.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.75,,,80.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.75,,,131.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,80.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.75,,,141.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,122.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,77.95,,,122.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,80.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.88,,,133.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.63,,,141.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.75,,,149.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.18,,,77.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,122.85,151.2,
HC XR MANDIBLE MIN 4 VIEWS,Px00032010007,CDM,70110,CPT,320,RC,,,,BOTH,,,158,142.2,150.1,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.24,,,123.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,80.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,80.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.68,,,151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.13,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.19,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.36,,,145.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,80.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.3,,,134.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.1,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,150.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,77.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,123.24,151.68,
HC XR CHEST 3 VIEWS,Px00032410016,CDM,71047,CPT,320,RC,,,,BOTH,,,158,142.2,150.1,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.24,,,123.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,80.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,131.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,80.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.68,,,151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.13,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.19,,,123.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.36,,,145.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,80.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.3,,,134.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.1,,,142.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.2,,,150.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.42,,,77.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,123.24,151.68,
HC RELOAD STAPER CART 30MMXR30B,Sx000000XR30B,CDM,,,270,RC,,,,BOTH,,,158.24,144.71,150.33,,,144.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.43,,,125.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.42,,,133.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.42,,,81.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.42,,,133.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,81.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.42,,,144.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.91,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.31,,,125.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.31,,,125.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.58,,,147.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,81.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.5,,,136.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.33,,,144.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.42,,,152.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.54,,,77.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,123.43,151.91,
HC VISTA RIGID CERVICAL COLLAR STANDARD WITH TRACHEAL OPENING,Sx00000984000,CDM,,,270,RC,,,,BOTH,,,158.65,231.3,150.72,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.75,,,200.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.79,,,213.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.79,,,130.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.79,,,213.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,130.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.79,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.3,,,246.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.61,,,200.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.52,,,200.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.96,,,236.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,130.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.85,,,218.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.72,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.79,,,244.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.74,,,77.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,123.75,152.3,
HC GUIDE WIRE 1.6X150MM ANCHORAGE,Sx000AGK16150,CDM,C1769,HCPCS,278,RC,,,,BOTH,,,159,143.1,151.05,,,143.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.02,,,124.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.1,,,132.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.1,,,81.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.1,,,132.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,81.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.1,,,143.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.64,,,152.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.87,,,124.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.69,,,124.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.28,,,146.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,81.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.15,,,135.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.05,,,143.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.1,,,151.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,77.91,,,77.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.02,152.64,
HC NEEDLE SCLEROTHERAPY INTERJECT 25GA 4MM EXTENSION 240CM,Sx00M00518361,CDM,,,270,RC,,,,BOTH,,,159.28,143.35,151.32,,,143.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.24,,,124.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.35,,,132.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.35,,,81.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.35,,,132.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.05,,,81.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.35,,,143.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.91,,,152.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.07,,,124.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.83,,,124.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.54,,,146.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.05,,,81.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.39,,,135.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.32,,,143.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.35,,,151.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.05,,,78.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.24,152.91,
HC PR 99221 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES CDM,Px00098710005,CDM,99221,CPT,987,RC,,,,BOTH,,,232,208.8,129.92,,,208.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.46,,,180.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145,,,193.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145,,,118.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145,,,193.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.67,,,118.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.77,,,208.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.6,,,135.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,180.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.24,,,213.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.1,,,118.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.24,,,197.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.92,,,208.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153,,,220.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,153,
HC PR 64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM,Px00096310238,CDM,64447,CPT,963,RC,,,,BOTH,,,123,110.7,68.88,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.73,,,95.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,104.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,70.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,104.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.81,,,70.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.94,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.73,,,89.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.42,,,95.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,57.81,,,95.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.73,,,113.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.43,,,62.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.11,,,104.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.88,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.45,,,116.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.2,,,75.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,57.81,153.45,
HC PR ED 64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM,Px00098100005,CDM,64447,CPT,981,RC,,,,OUTPATIENT,,,123,110.7,68.88,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.73,,,95.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,104.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,70.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.88,,,104.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.71,,,70.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.94,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.65,,,89.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.49,,,95.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.49,,,95.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.11,,,113.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.33,,,62.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.11,,,104.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.88,,,110.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.45,,,116.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.49,,,61.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,61.49,153.45,
HC IV INFUSION EA ADDL HR,Px00026010010,CDM,96366,CPT,761,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC PICC UNIVERSAL INTRODUCER 5FR,Px00007472WNH,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC K WIRE STANDARD TIP 1.5X127MM DISPOSABLE,SxKWIR-STD-15,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC K-WIRE STANDARD 9X152MM,SxKWIR-STD-09,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC PASSPORT BUTTON 8X12 MM,SxAR-6592-08-,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC PASSPORT BUTTON CANNULA,SxAR-6592-10-,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC GEMINI SR8 CANNULA SYSTEM,Sx0000AR-6572,CDM,,,270,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC XR ENTIRE SPINE 1 VIEW,Px00032010604,CDM,72081,CPT,320,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC XR SHOULDER A-C JOINTS BIL,Px00032010099,CDM,73050,CPT,320,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC BREAST TOMOSYNTHESIS UNI,Px00040110018,CDM,77061,CPT,401,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC BREAST TOMOSYNTHESIS BI,Px00040110019,CDM,77062,CPT,401,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
"HC TOMOSYNTHESIS, MAMMO UNI OR BIL DIAGNOSTIC",Px00040110021,CDM,G0279,CPT,401,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC SCREENING BREAST TOMOSYNTHESIS BI,Px00040110020,CDM,77063,CPT,403,RC,,,,BOTH,,,160,144,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.8,,,124.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,81.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,133.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.6,,,153.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.18,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.2,,,147.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,81.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136,,,136,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152,,,144,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144,,,152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.4,,,78.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,124.8,153.6,
HC R&B HOSPICE RESPITE,Px00065510001,CDM,,,655,RC,,,,INPATIENT,,,161,144.9,152.95,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.58,,,125.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,82.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.34,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.12,,,148.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.85,,,136.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.95,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,152.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,78.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,125.58,154.56,
HC BRACE ANKLE AIR STRUP,Px00032200WNH,CDM,L4350,CPT,274,RC,,,,BOTH,,,161,144.9,152.95,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.58,,,125.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,82.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.34,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.68,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.12,,,148.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.85,,,136.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.95,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.9,,,152.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,78.89,,,78.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,125.58,154.56,
HC PR 56420 I&D OF BARTHOLINS GLAND ABSCESS  CDM,Px00097514088,CDM,56420,CPT,975,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.7,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.56,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.89,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,125.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.56,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,108.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,108.31,154.8,
HC KIT INTRODUCER PICC UN 5 PC KIT,Sx00000678950,CDM,,,270,RC,,,,BOTH,,,163.3,146.97,155.14,,,146.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.37,,,127.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.97,,,135.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.97,,,83.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.97,,,135.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.02,,,83.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.97,,,146.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.77,,,156.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.03,,,127.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.82,,,127.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.24,,,150.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.02,,,83.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138.81,,,138.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.14,,,146.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.97,,,155.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.02,,,80.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,127.37,156.77,
HC PR ED 10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE CDM,Px00098110040,CDM,10021,CPT,981,RC,,,,OUTPATIENT,,,248,223.2,138.88,,,223.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.85,,,193.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155,,,233.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,155,,,233.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.21,,,223.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.4,,,96.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.26,,,193.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,53.26,,,193.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.36,,,228.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,54.86,,,126.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.36,,,210.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.88,,,223.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.05,,,235.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,53.26,,,53.26,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,53.26,157.05,
HC XR KNEE 3 VIEWS,Px00032010152,CDM,73562,CPT,320,RC,,,,BOTH,,,164,147.6,155.8,,,147.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.92,,,127.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.6,,,136.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.6,,,83.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.6,,,136.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.36,,,83.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.6,,,147.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.44,,,157.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.54,,,127.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.16,,,127.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.88,,,150.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.36,,,83.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.4,,,139.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.8,,,147.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.6,,,155.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,80.36,,,80.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,127.92,157.44,
HC PR ED 11400 EXC SKIN BENIG <5MM TRUNK ARM LEG CDM,Px00098100001,CDM,11400,CPT,981,RC,,,,OUTPATIENT,,,322,289.8,180.32,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,251.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,285.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,285.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.18,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.5,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.1,,,106.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.5,,,251.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.5,,,251.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.54,,,296.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.04,,,164.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.54,,,273.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,180.32,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.51,,,305.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.5,,,84.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.5,157.51,
HC PR 99239 HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN CDM,Px00098710018,CDM,99239,CPT,987,RC,,,,BOTH,,,245,220.5,137.2,,,220.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.99,,,191.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.13,,,205.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.13,,,129.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.13,,,205.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,19.26,,,129.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.67,,,220.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,134.75,,,142.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,191.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.65,,,225.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.88,,,124.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.65,,,208.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,220.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.13,,,232.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,159.13,
HC PR 64486 TAP BLOCK UNIL BY INJECTION,Px00096310277,CDM,64486,CPT,963,RC,,,,BOTH,,,166,149.4,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.61,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.75,,,138.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.02,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.08,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.48,,,159.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.64,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.02,,,129.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.48,,,152.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.85,,,84.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,94.62,,,141.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.96,,,149.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,157.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.39,,,64.39,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,78.02,159.3,
HC ED REMOVE IMPACTED EAR WAX CDM,Px00045010491,CDM,69210,CPT,450,RC,,,,OUTPATIENT,,,166,117.9,157.7,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.48,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,160.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,160.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.36,,,45.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.01,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.15,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,152.72,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.1,,,122.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.7,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,136.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,81.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,129.48,159.36,
HC ED STRAPPING OF ELBOW OR WRIST CDM,Px00045010834,CDM,29260,CPT,450,RC,,,,OUTPATIENT,,,166,117.9,157.7,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.48,,,112.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,73.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,119.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.36,,,138.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.01,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.15,,,112.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,152.72,,,132.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,73.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.1,,,122.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.7,,,129.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,136.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,81.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,129.48,159.36,
HC CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,Px00031110064,CDM,88112,CPT,300,RC,,,,BOTH,,,166,149.4,157.7,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.48,,,129.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,138.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,84.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,138.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,84.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.36,,,159.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.01,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.15,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,152.72,,,152.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,84.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.1,,,141.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.7,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,157.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,81.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,129.48,159.36,
HC XR WRIST COMPLETE MIN 3 VIEWS,Px00032010119,CDM,73110,CPT,320,RC,,,,BOTH,,,166,149.4,157.7,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.48,,,129.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,138.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,84.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,138.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,84.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.36,,,159.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.01,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.15,,,129.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,152.72,,,152.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,84.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.1,,,141.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.7,,,149.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.4,,,157.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.34,,,81.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,129.48,159.36,
HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM,Px00098110102,CDM,92960,CPT,981,RC,,,,OUTPATIENT,,,254,228.6,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.05,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.31,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.31,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.7,,,243.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.62,,,198.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.62,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,233.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.76,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,215.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,241.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.62,,,104.62,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,104.62,160.23,
HC XR SACROILIAC JOINTS 1-2 VIEWS,Px00032010073,CDM,72200,CPT,320,RC,,,,BOTH,,,167,150.3,158.65,,,150.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.26,,,130.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.3,,,139.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.3,,,85.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.3,,,139.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.83,,,85.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.3,,,150.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.32,,,160.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.75,,,130.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.65,,,130.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.64,,,153.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.83,,,85.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.95,,,141.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.65,,,150.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.3,,,158.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,81.83,,,81.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.26,160.32,
HC DRESSING SMALL FOR EXTRICARE NEG-PRESSURE,Sx00EC2400-SO,CDM,,,270,RC,,,,BOTH,,,167.5,150.75,159.13,,,150.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.65,,,130.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,139.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,85.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,139.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,85.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,150.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.8,,,160.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.11,,,130.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,82.9,,,130.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.1,,,154.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,85.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.38,,,142.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.13,,,150.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,159.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.08,,,82.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.65,160.8,
HC Radial Jaw 4 Jumbo Forceps,Sx00M00513361,CDM,,,270,RC,,,,BOTH,,,167.94,151.15,159.54,,,151.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.99,,,131,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.15,,,139.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.15,,,85.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.15,,,139.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.29,,,85.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.15,,,151.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.22,,,161.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.44,,,131,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.11,,,131,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.5,,,154.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.29,,,85.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.75,,,142.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.54,,,151.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.15,,,159.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.29,,,82.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.99,161.22,
HC ASSAY OF ESTRIOL #,Px00030100128,CDM,82677,CPT,300,RC,,,,BOTH,,,168,151.2,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.04,,,131.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,85.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.28,,,161.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.14,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.8,,,142.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,159.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,82.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,131.04,161.28,
HC ASSAY OF ESTRIOL #,Px00030100597,CDM,82677,CPT,300,RC,,,,BOTH,,,168,151.2,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.04,,,131.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,85.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.28,,,161.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.14,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.8,,,142.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,159.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,82.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,131.04,161.28,
HC PRENATAL-ESTRIOL,Px00030015746,CDM,82677,CPT,300,RC,,,,BOTH,,,168,151.2,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.04,,,131.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,85.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.28,,,161.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.14,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.8,,,142.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,159.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,82.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,131.04,161.28,
HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R #,Px00031010498,CDM,88312,CPT,300,RC,,,,BOTH,,,168,151.2,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.04,,,131.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,85.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,139.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.28,,,161.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.14,,,131.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.56,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,85.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.8,,,142.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.6,,,151.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.2,,,159.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,82.32,,,82.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,131.04,161.28,
HC PR ED 67800 EXCIS CHALAZION SINGLE CDM,Px00098100007,CDM,67800,CPT,981,RC,,,,OUTPATIENT,,,412,370.8,230.72,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.39,,,321.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,342.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,342.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.59,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.84,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.6,,,395.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.51,,,321.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.51,,,321.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.84,,,379.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.53,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.84,,,350.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.72,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.55,,,391.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.51,,,100.51,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,100.51,161.55,
HC PR 99463 NEWBORN DISCHARGE SAME DAY,Px00096910632,CDM,99463,CPT,987,RC,,,,BOTH,,,254,228.6,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.23,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.16,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.23,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.7,,,243.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,198.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,233.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.62,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,215.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.75,,,241.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,58.59,,,58.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,58.59,162.75,
HC PR ED 12004 REPAIR SUPERFIC WOUND(S)7.6 TO 12.5CM SLP NK AX EXGEN T CDM,Px00098110261,CDM,12004,CPT,981,RC,,,,OUTPATIENT,,,174,156.6,97.44,,,156.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.81,,,135.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.75,,,181.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.75,,,181.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.49,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.23,,,156.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.7,,,100.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.99,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.99,,,135.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.18,,,160.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.09,,,88.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.18,,,147.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.44,,,156.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,165.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.99,,,69.99,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,69.99,162.9,
HC ECG 12 LEAD TRACING ONLY SUBSEQUENT,Px00073010015,CDM,93005,CPT,730,RC,,,,BOTH,,,170,153,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.6,,,132.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,86.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.2,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.4,,,156.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.5,,,144.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,161.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,83.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.6,163.2,
HC ECG 12 LEAD TRACING ONLY,Px00073010002,CDM,93005,CPT,730,RC,,,,BOTH,,,170,153,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.6,,,132.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,86.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.2,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.4,,,156.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.5,,,144.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,161.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,83.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.6,163.2,
HC ORAL FUNCTION THERAPY,Px00044010042,CDM,92526,CPT,440,RC,,,,BOTH,,,170,153,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.6,,,132.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,86.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,141.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.2,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.13,,,132.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.4,,,156.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,86.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.5,,,144.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.5,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153,,,161.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.3,,,83.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,132.6,163.2,
HC PR ED 64400 NERVE BLOCK INJ TRIGEMINAL CDM,Px00098110814,CDM,64400,CPT,981,RC,,,,OUTPATIENT,,,119,107.1,66.64,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.94,,,92.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.38,,,99.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.38,,,60.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.38,,,99.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.96,,,60.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.36,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.45,,,114.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,92.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,92.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.83,,,109.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,51.91,,,60.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.83,,,101.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.64,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.35,,,113.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.4,,,50.4,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,50.4,163.35,
HC PR 99292 CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN CDM,Px00098700003,CDM,99292,CPT,987,RC,,,,BOTH,,,254,228.6,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.36,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.4,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.73,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.7,,,243.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,198.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,233.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.05,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,215.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,241.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,102.96,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,102.96,163.75,
HC XR PELVIS MIN 3 VIEWS,Px00032010072,CDM,72190,CPT,320,RC,,,,BOTH,,,171,153.9,162.45,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.38,,,133.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,142.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,87.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,142.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,87.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.16,,,164.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.69,,,133.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.63,,,133.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.32,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,87.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.45,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,162.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,83.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,133.38,164.16,
HC EVALUATE SPEECH PRODUCTION,Px00044410064,CDM,92522,CPT,444,RC,,,,BOTH,,,171,153.9,162.45,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.38,,,133.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,142.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,87.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,142.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,87.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.16,,,164.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.69,,,133.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.63,,,133.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.32,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,87.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.35,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.45,,,153.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.9,,,162.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.79,,,83.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,133.38,164.16,
HC BIOMET BONE CEMENT R 1X40 US,Sx00110035368,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,171.36,151.2,162.79,,,154.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.66,,,133.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.22,,,142.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.22,,,87.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.22,,,142.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,87.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.22,,,154.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.51,,,164.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.95,,,133.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.81,,,133.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.65,,,157.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,87.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,145.66,,,145.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.79,,,154.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.22,,,162.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,83.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,133.66,164.51,
HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE,Px00030016255,CDM,87493,CPT,300,RC,,,,BOTH,,,172,154.8,163.4,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.16,,,134.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,143.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,87.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,143.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,87.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.12,,,165.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.42,,,134.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.12,,,134.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.24,,,158.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,87.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.2,,,146.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.4,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,163.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,84.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,134.16,165.12,
HC PR 99464 ATTENDANCE/DELIVERY,Px00096910633,CDM,99464,CPT,410,RC,,,,BOTH,,,172,154.8,163.4,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.16,,,134.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,143.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,87.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,143.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,87.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.12,,,165.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,126.42,,,134.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.12,,,134.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.24,,,158.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,87.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.2,,,146.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.4,,,154.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.8,,,163.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.28,,,84.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,134.16,165.12,
HC PR ED 64417 INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM,Px00098100004,CDM,64417,CPT,981,RC,,,,OUTPATIENT,,,142,127.8,79.52,,,127.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.26,,,110.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.75,,,118.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.75,,,72.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.75,,,118.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.91,,,72.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.6,,,127.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.1,,,136.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.53,,,110.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,62.53,,,110.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.94,,,130.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.41,,,72.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.94,,,120.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.52,,,127.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,134.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,62.53,,,62.53,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,62.53,165.6,
HC PR 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,Px00098310220,CDM,10160,CPT,983,RC,,,,BOTH,,,222,199.8,124.32,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.34,,,173.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.41,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.41,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.1,,,129.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,173.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,173.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.54,,,204.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.89,,,113.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.54,,,188.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.32,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.05,,,210.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,96.01,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,96.01,166.05,
HC PR ED 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM,Px00098110238,CDM,10160,CPT,981,RC,,,,OUTPATIENT,,,222,199.8,124.32,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.34,,,173.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.75,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.41,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.41,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.1,,,129.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,173.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,173.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.54,,,204.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.89,,,113.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.54,,,188.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.32,,,199.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.05,,,210.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.01,,,96.01,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,96.01,166.05,
HC NEEDLE TRU-CUT 14G 6 IN 20 MM SPECIMEN NOTCH 2N2704T,Sx00002N2704X,CDM,,,270,RC,,,,BOTH,,,173.39,69.74,164.72,,,156.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.24,,,135.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.05,,,144.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.05,,,88.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.05,,,144.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.96,,,88.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.05,,,156.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.45,,,166.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.44,,,135.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,85.81,,,135.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.52,,,159.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.96,,,88.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.38,,,147.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.72,,,156.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.05,,,164.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,84.96,,,84.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.24,166.45,
HC ESTRONE SERUM,Px00030012037,CDM,82679,CPT,300,RC,,,,BOTH,,,174,156.6,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.72,,,135.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.89,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.08,,,160.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.9,,,147.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,165.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,85.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.72,167.04,
HC GASTRIN,Px00030014962,CDM,82941,CPT,300,RC,,,,BOTH,,,174,156.6,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.72,,,135.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.89,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.08,,,160.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.9,,,147.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,165.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,85.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.72,167.04,
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ #,Px00030610482,CDM,87635,CPT,300,RC,,,,BOTH,,,174,156.6,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.72,,,135.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.89,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.08,,,160.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.9,,,147.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,165.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,85.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.72,167.04,
HC BEHAVRAL QUALIT ANALYS VOICE,Px00044010127,CDM,92524,CPT,444,RC,,,,BOTH,,,174,156.6,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.72,,,135.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,88.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,144.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,127.89,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.11,,,135.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.08,,,160.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,88.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.9,,,147.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,156.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.6,,,165.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.26,,,85.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,135.72,167.04,
HC PR 00770 ANESTH BLOOD VESSEL REPAIR,Px00096310063,CDM,770,CPT,963,RC,,,,BOTH,,,258,232.2,144.48,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.74,,,205.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.25,,,219.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.25,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.25,,,219.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.26,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.26,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.9,,,253.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.32,,,205.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.26,,,205.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.06,,,242.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.55,,,134.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.06,,,224.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.48,,,237.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.7,,,250.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,121.26,167.7,BASE FEE
HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,Px00031010389,CDM,88342,CPT,300,RC,,,,BOTH,,,175,157.5,166.25,,,157.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.5,,,136.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.5,,,145.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.5,,,89.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.5,,,145.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.75,,,89.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.5,,,157.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168,,,168,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.63,,,136.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,86.61,,,136.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161,,,161,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.75,,,89.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.75,,,148.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.25,,,157.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.5,,,166.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,85.75,,,85.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,136.5,168,
HC ED STRAPPING OF TOES CDM,Px00045013139,CDM,29550,CPT,450,RC,,,,OUTPATIENT,,,176,125.1,167.2,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,119.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,77.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,127.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.96,,,146.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.1,,,119.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.92,,,140.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,77.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.6,,,130.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.2,,,137.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,145.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,86.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,168.96,
HC DHEA QUANT,Px00030014683,CDM,82626,CPT,300,RC,,,,BOTH,,,176,158.4,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,89.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.96,,,168.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.1,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.92,,,161.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.6,,,149.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,167.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,86.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,168.96,
HC XR FACIAL BONES MIN 3 VIEWS,Px00032010012,CDM,70150,CPT,320,RC,,,,BOTH,,,176,158.4,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,89.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.96,,,168.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.1,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.92,,,161.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.6,,,149.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,167.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,86.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,168.96,
HC XR ORBITS MIN 4 VIEWS,Px00032010017,CDM,70200,CPT,320,RC,,,,BOTH,,,176,158.4,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,89.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.96,,,168.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.1,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.92,,,161.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.6,,,149.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,167.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,86.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,168.96,
HC XR SKULL MIN 4 VIEWS,Px00032010023,CDM,70260,CPT,320,RC,,,,BOTH,,,176,158.4,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.28,,,137.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,89.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.96,,,168.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.1,,,137.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.92,,,161.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,89.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.6,,,149.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.2,,,158.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.4,,,167.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.24,,,86.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,137.28,168.96,
HC ASSAY OF TESTOSTERONE FREE #,Px00030100653,CDM,84402,CPT,300,RC,,,,BOTH,,,177,159.3,168.15,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.06,,,138.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,147.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,90.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,147.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,90.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.92,,,169.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.1,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.6,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.84,,,162.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,90.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.45,,,150.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.15,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,168.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,86.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.06,169.92,
HC ASSAY OF TESTOSTERONE FREE #,Px00030110193,CDM,84402,CPT,300,RC,,,,BOTH,,,177,159.3,168.15,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.06,,,138.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,147.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,90.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,147.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,90.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.92,,,169.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.1,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.6,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.84,,,162.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,90.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.45,,,150.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.15,,,159.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.3,,,168.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,86.73,,,86.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.06,169.92,
HC PR ED 12014 REPAIR SUPERFIC WOUND(S) 5.1 TO 7.5CM FACE ERS EYLD NSE CDM,Px00098110267,CDM,12014,CPT,981,RC,,,,OUTPATIENT,,,177,159.3,99.12,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.21,,,138.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,147.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.63,,,147.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.32,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.12,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.35,,,169.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.71,,,138.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.71,,,138.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.89,,,162.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.83,,,90.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.89,,,150.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.12,,,159.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,168.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.71,,,70.71,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.71,170.1,
HC PR 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<  CDM,Px00097514018,CDM,13122,CPT,975,RC,,,,BOTH,,,192,172.8,107.52,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.36,,,149.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,159.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,159.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.41,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,184.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,149.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,176.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.65,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,163.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.52,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,182.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,79.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,79.27,170.1,
HC PR ED 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< CDM,Px00098110299,CDM,13122,CPT,981,RC,,,,OUTPATIENT,,,192,172.8,107.52,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.36,,,149.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,159.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120,,,159.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.16,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.41,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.6,,,184.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,149.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,176.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.65,,,97.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.44,,,163.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.52,,,172.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,182.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.27,,,79.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,79.27,170.1,
HC INJ SQ OR IM,Px00094010205,CDM,96372,CPT,761,RC,,,,BOTH,,,178,133.2,169.1,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,115.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,162.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,162.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,142.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,115.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,136.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,75.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,125.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,133.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,140.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,87.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC BLOOD TYPING RBC ANTIGENS,Px00030011114,CDM,86905,CPT,300,RC,,,,BOTH,,,178,151.2,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,138.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,90.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,170.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.09,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,163.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,151.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,169.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,87.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT #,Px00031010330,CDM,88173,CPT,300,RC,,,,BOTH,,,178,160.2,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,138.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,90.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,170.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.09,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,163.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,151.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,169.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,87.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC XR HIPS BIL 2 VIEWS,Px00032010611,CDM,73521,CPT,320,RC,,,,BOTH,,,178,160.2,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,138.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,90.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,170.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.09,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,163.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,151.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,169.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,87.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC XR ABDOMEN COMPLETE SERIES,Px00032010175,CDM,74022,CPT,320,RC,,,,BOTH,,,178,160.2,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,138.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,90.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,148.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,170.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.09,,,138.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,163.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,90.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,151.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,160.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,169.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,87.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC XR KNEE 4+ VIEWS,Px00032010154,CDM,73564,CPT,320,RC,,,,BOTH,,,300,160.2,169.1,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.84,,,234,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,249,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,249,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,153,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.88,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.83,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,88.09,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.76,,,276,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,153,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.3,,,255,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.1,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.2,,,285,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,87.22,,,147,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.84,170.88,
HC PR ED 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM,Px00098110716,CDM,24640,CPT,981,RC,,,,OUTPATIENT,,,189,170.1,105.84,,,170.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.2,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,157.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,96.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.13,,,157.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,90.22,,,96.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.31,,,170.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,181.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.45,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.45,,,147.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.73,,,173.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.8,,,96.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.73,,,160.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.84,,,170.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,179.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.45,,,78.45,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,78.45,172.35,
HC ALEXIS O WOUND PROTECTOR SMALL RETRACTOR 2.5 - 6CM,Sx000000C8301,CDM,,,270,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC ALEXIS O WOUND PROTECTOR MED RETRACTOR 5 - 9CM MEDIUM,Sx000000C8302,CDM,,,270,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC AIM GUIDES 1.5MM DISPOSABLE,SxPDG-AIM-015,CDM,,,270,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC SCREW LO-PROFILE TI 3.5 X 12MM,Sx0AR-8935-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC SCREW LO-PROFILE TI 3.5 X 22MM,Sx0AR-8935-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC SCREW LO-PROFILE TI 3.5 X 20MM,Sx0AR-8935-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,180,162,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.4,,,140.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,91.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,149.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.08,,,140.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,91.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,162,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.2,,,88.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,140.4,172.8,
HC PR 29445 CONTACT CAST APPLICATION,Px00098210123,CDM,29445,CPT,982,RC,,,,BOTH,,,239,215.1,133.84,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.57,,,186.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.38,,,196.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.38,,,111.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.38,,,196.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.35,,,111.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.59,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,131.45,,,229.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.96,,,186.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.96,,,186.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.23,,,219.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.84,,,111.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.23,,,203.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,133.84,,,215.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.25,,,227.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.96,,,95.96,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,95.96,173.25,
HC VIRAL CULTURE,Px00030610035,CDM,87252,CPT,300,RC,,,,BOTH,,,181,162.9,171.95,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.18,,,141.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,150.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,92.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,150.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,92.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.76,,,173.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.04,,,141.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.58,,,141.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.52,,,166.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,92.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.85,,,153.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.95,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,171.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,88.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,141.18,173.76,
HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM,Px00040210112,CDM,76882,CPT,402,RC,,,,BOTH,,,181,162.9,171.95,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.18,,,141.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,150.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,92.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,150.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,92.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.76,,,173.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.04,,,141.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.58,,,141.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.52,,,166.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,92.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.85,,,153.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.95,,,162.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.9,,,171.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,88.69,,,88.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,141.18,173.76,
HC PR 64445 INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM,Px00096310256,CDM,64445,CPT,963,RC,,,,BOTH,,,126,113.4,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,66.62,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,109.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,80.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.75,,,109.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.22,,,80.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.39,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,98.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,68.04,,,98.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,59.22,,,98.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,115.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.85,,,64.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.82,,,107.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,113.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.15,,,119.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.02,,,78.02,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,59.22,174.15,
HC XR SPINE CERVICAL 4 OR 5 VIEWS,Px00032010056,CDM,72050,CPT,320,RC,,,,BOTH,,,182,163.8,172.9,,,163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.96,,,141.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,151.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,92.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,151.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.18,,,92.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.72,,,174.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.77,,,141.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.07,,,141.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.44,,,167.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.18,,,92.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.7,,,154.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.9,,,163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,172.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.18,,,89.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,141.96,174.72,
ZIDOVUDINE IV SOLN 10 MG/ML,Rx49702021301,CDM,J3485,HCPCS,636,RC,49702021301,NDC,,BOTH,1,ML,182.65,164.39,173.52,,,164.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.47,,,142.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.39,,,152.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.39,,,93.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.39,,,152.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.5,,,93.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.39,,,164.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.34,,,175.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.25,,,142.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.5,,,142.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.04,,,168.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.5,,,93.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.25,,,155.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.52,,,164.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.39,,,173.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.5,,,89.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,142.47,175.34,
HC DIHYDROTESTOSTERONE (DHT),Px00030110220,CDM,82642,CPT,300,RC,,,,BOTH,,,183,164.7,173.85,,,164.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.74,,,142.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.7,,,152.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.7,,,93.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.7,,,152.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,93.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.7,,,164.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.68,,,175.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.51,,,142.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.57,,,142.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.36,,,168.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,93.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.55,,,155.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.85,,,164.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.7,,,173.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.67,,,89.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,142.74,175.68,
HC RELOAD STAPLER CARTRIDGE TCR55,Sx000000TCR55,CDM,,,270,RC,,,,BOTH,,,183.14,167.48,173.98,,,167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.85,,,145.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.83,,,154.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.83,,,94.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.83,,,154.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.74,,,94.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.83,,,167.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.81,,,178.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.61,,,145.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.64,,,145.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.49,,,171.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.74,,,94.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.67,,,158.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.98,,,167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.83,,,176.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.74,,,89.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,142.85,175.81,
ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML,Rx00075801801,CDM,J1650,HCPCS,636,RC,75801801,NDC,,BOTH,0.8,ML,183.4,165.06,174.23,,,165.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.05,,,143.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.06,,,152.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.06,,,93.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.06,,,152.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.87,,,93.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.06,,,165.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.06,,,176.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.8,,,143.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.87,,,143.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.73,,,168.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.87,,,93.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.89,,,155.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.23,,,165.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.06,,,174.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,89.87,,,89.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.05,176.06,
HC SUTURETAPE 1.3MM W/TAILS WHITE/BLUE,Sx0000AR-7500,CDM,,,270,RC,,,,BOTH,,,183.75,165.38,174.56,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,143.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.38,,,152.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.38,,,93.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.38,,,152.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,93.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.38,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.06,,,143.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,90.94,,,143.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,93.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.19,,,156.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.56,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.38,,,174.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.04,,,90.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.33,176.4,
HC XR ARM INFANT MIN 2 VIEWS,Px00032010115,CDM,73092,CPT,320,RC,,,,BOTH,,,184,165.6,174.8,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.52,,,143.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,153.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,93.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,153.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.16,,,93.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.64,,,176.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.24,,,143.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.06,,,143.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.28,,,169.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.16,,,93.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.4,,,156.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.8,,,165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.6,,,174.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.16,,,90.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.52,176.64,
HC FOAM WHITE VAC MED KIT FOR PROSPERA,Sx0000NP-0101,CDM,,,270,RC,,,,BOTH,,,184.75,166.28,175.51,,,166.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.11,,,144.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.28,,,153.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.28,,,94.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.28,,,153.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,94.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.28,,,166.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.36,,,177.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.79,,,144.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.43,,,144.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.97,,,169.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,94.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.04,,,157.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.51,,,166.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.28,,,175.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.53,,,90.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.11,177.36,
HC ED IV INFUSION THERAPY PROPHYLAXIS ADDL SEQUENTIAL TO 1 HR CDM,Px00045011002,CDM,96367,CPT,450,RC,,,,OUTPATIENT,,,185,131.4,175.75,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.3,,,125.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.5,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.5,,,82.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.5,,,134.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.65,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.5,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.6,,,154.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.98,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.56,,,125.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.2,,,148.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.65,,,82.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.25,,,136.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.75,,,144.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.5,,,152.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.65,,,90.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.3,177.6,
HC FOAM VAC SMALL BLACK,Px00008620WNH,CDM,,,270,RC,,,,BOTH,,,185.35,166.82,176.08,,,166.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.57,,,144.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,154.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,94.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,154.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.82,,,94.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,166.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.94,,,177.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.23,,,144.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.73,,,144.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,170.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.82,,,94.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.55,,,157.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.08,,,166.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,176.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.82,,,90.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.57,177.94,
HC NASAL PAC RHINO 5.5CM GEL NET,Px00005206WNH,CDM,,,270,RC,,,,BOTH,,,185.5,166.95,176.23,,,166.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.69,,,144.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.95,,,154.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.95,,,94.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.95,,,154.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,94.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.95,,,166.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.08,,,178.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.34,,,144.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,144.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.66,,,170.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,94.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.68,,,157.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.23,,,166.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.95,,,176.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.9,,,90.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.69,178.08,
"HC HEMOSTATIC AGENT 1/2""X 2""",Px00005452WNH,CDM,,,270,RC,,,,BOTH,,,185.6,167.04,176.32,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.77,,,144.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,154.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,94.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,154.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.94,,,94.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.18,,,178.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.42,,,144.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.85,,,144.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.75,,,170.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.94,,,94.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.76,,,157.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.32,,,167.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.04,,,176.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,90.94,,,90.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.77,178.18,
HC ENDO LIGACLIP APPLIER,Sx000000MCM20,CDM,,,270,RC,,,,BOTH,,,185.85,173.9,176.56,,,173.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.96,,,150.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.27,,,160.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.27,,,98.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.27,,,160.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.07,,,98.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.27,,,173.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.42,,,185.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.6,,,150.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.98,,,150.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.98,,,177.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.07,,,98.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.97,,,164.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.56,,,173.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.27,,,183.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.07,,,91.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,144.96,178.42,
HC MRSA PCR,Px00030211050,CDM,87641,CPT,610,RC,,,,BOTH,,,186,167.4,176.7,,,167.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.08,,,145.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.4,,,154.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.4,,,94.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.4,,,154.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,94.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.4,,,167.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.56,,,178.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.71,,,145.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,145.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171.12,,,171.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,94.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.1,,,158.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.7,,,167.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.4,,,176.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.14,,,91.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,145.08,178.56,
HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM,Px00045011013,CDM,96372,CPT,450,RC,,,,OUTPATIENT,,,187,133.2,177.65,,,146.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.86,,,127.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,173.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,173.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.63,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,146.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.52,,,156.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.45,,,127.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.55,,,127.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.04,,,149.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.63,,,83.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.95,,,138.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.65,,,146.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,154.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.63,,,91.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,145.86,179.52,
"HC PR 15271 GRAFT TRUNK,ARM.LEG, TOTAL TO 100 SQCM; 1ST 25 SQCM",Px00098210036,CDM,15271,CPT,982,RC,,,,BOTH,,,368,331.2,206.08,,,331.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.09,,,287.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230,,,282.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230,,,94.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230,,,282.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.79,,,94.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.41,,,331.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.4,,,353.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.56,,,287.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.56,,,287.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,338.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.01,,,94.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,312.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.08,,,331.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,179.55,,,349.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.56,,,81.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,81.56,179.55,
HC CHEST DRAIN (ER),Px00004057WNH,CDM,,,270,RC,,,,BOTH,,,187.4,168.66,178.03,,,168.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.17,,,146.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.66,,,155.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.66,,,95.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.66,,,155.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.83,,,95.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.66,,,168.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.9,,,179.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.74,,,146.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.74,,,146.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.41,,,172.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.83,,,95.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.29,,,159.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.03,,,168.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.66,,,178.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.83,,,91.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,146.17,179.9,
HC SAM PELVIC II SLING STANDARD,Sx00000563498,CDM,L2580,HCPCS,274,RC,,,,BOTH,,,187.65,168.89,178.27,,,168.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.37,,,146.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.89,,,156.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.89,,,95.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.89,,,156.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.95,,,95.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.89,,,168.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.14,,,180.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.92,,,146.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,92.87,,,146.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.64,,,172.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.95,,,95.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.5,,,159.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.27,,,168.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.89,,,178.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,91.95,,,91.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,146.37,180.14,
"HC ORTHOTIC MGMT AND TRAINING, EA 15 MIN",Px00042010264,CDM,97760,CPT,420,RC,,,,BOTH,,,188,169.2,178.6,,,169.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.64,,,146.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,156.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,95.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,156.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.12,,,95.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,169.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.48,,,180.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.18,,,146.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.04,,,146.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.96,,,172.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.12,,,95.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.8,,,159.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.6,,,169.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,178.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.12,,,92.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,146.64,180.48,
HC SCREW LO-PROFILE TI 3.5 X 16MM,Sx0AR-8935-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,189,170.1,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.42,,,147.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,96.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.44,,,181.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.92,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.54,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173.88,,,173.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.65,,,160.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,179.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,92.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,147.42,181.44,
HC XR HIPS UNI W PELVIS 2-3 VIEWS,Px00032010609,CDM,73502,CPT,320,RC,,,,BOTH,,,189,170.1,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.42,,,147.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,96.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.44,,,181.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.92,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.54,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173.88,,,173.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.65,,,160.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,179.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,92.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,147.42,181.44,
HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM,Px00040210052,CDM,76942,CPT,402,RC,,,,BOTH,,,189,170.1,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.42,,,147.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,96.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,157.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.44,,,181.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,138.92,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,93.54,,,147.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173.88,,,173.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,96.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.65,,,160.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.55,,,170.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.1,,,179.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,92.61,,,92.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,147.42,181.44,
HC TOURNIQUET EXTREME FORCE WITH WINDLASS FOR ER,Sx301-SAMXT-B,CDM,,,270,RC,,,,BOTH,,,189.95,170.96,180.45,,,170.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.16,,,148.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.96,,,158.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.96,,,96.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.96,,,158.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.08,,,96.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.96,,,170.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.35,,,182.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.61,,,148.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.01,,,148.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.75,,,174.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.08,,,96.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.45,,,170.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.96,,,180.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.08,,,93.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,148.16,182.35,
HC MARKER GI TRACT NON-INDIA INK,Sx00000GIS-45,CDM,,,270,RC,,,,BOTH,,,190,171,180.5,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.2,,,148.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,158.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,96.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,158.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.1,,,96.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.4,,,182.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.65,,,148.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.03,,,148.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.8,,,174.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.1,,,96.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.5,,,161.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.5,,,171,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171,,,180.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.1,,,93.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,148.2,182.4,
HC STAPLER PURSTRING 65 SS 2-0 DISP,Sx00000020242,CDM,,,270,RC,,,,BOTH,,,190.03,171.03,180.53,,,171.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.22,,,148.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.03,,,158.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.03,,,96.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.03,,,158.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.11,,,96.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171.03,,,171.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.43,,,182.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.67,,,148.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.05,,,148.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.83,,,174.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.11,,,96.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.53,,,161.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.53,,,171.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.03,,,180.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.11,,,93.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,148.22,182.43,
HC PR ED 99284 VISIT MODERATE MDM CDM,Px00098110012,CDM,99284,CPT,981,RC,,,,OUTPATIENT,,,286,257.4,160.16,,,257.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,131.43,,,223.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.75,,,238.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.75,,,145.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.75,,,238.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.68,,,145.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.15,,,257.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.3,,,274.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,223.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,223.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.02,,,263.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,145.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.44,,,243.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.16,,,257.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,271.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,183.75,
HC NASAL PAC THINO 7.5 GEL NET,Px00005205WNH,CDM,,,270,RC,,,,BOTH,,,191.5,172.35,181.93,,,172.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.37,,,149.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,159.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,97.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,159.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,97.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,172.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.84,,,183.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.75,,,149.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,94.77,,,149.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.18,,,176.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,97.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.78,,,162.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.93,,,172.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.35,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,93.84,,,93.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,149.37,183.84,
HC SENSORMAT LT CHAIR,Px00007781WNH,CDM,,,270,RC,,,,BOTH,,,192,172.8,182.4,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.76,,,149.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,159.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,97.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,159.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,97.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.32,,,184.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.12,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.02,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.64,,,176.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,97.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.2,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.4,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,182.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,94.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,149.76,184.32,
HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL #,Px00031010566,CDM,88360,CPT,300,RC,,,,BOTH,,,192,172.8,182.4,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.76,,,149.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,159.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,97.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,159.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,97.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.32,,,184.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.12,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.02,,,149.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.64,,,176.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,97.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.2,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.4,,,172.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.8,,,182.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.08,,,94.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,149.76,184.32,
HC PR 99234 HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN CDM,Px00098710024,CDM,99234,CPT,987,RC,,,,BOTH,,,303,272.7,169.68,,,272.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.69,,,236.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.38,,,241.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.38,,,109.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.38,,,241.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.33,,,109.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.22,,,272.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.65,,,180.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,236.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,236.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.71,,,278.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.03,,,154.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.71,,,257.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.68,,,272.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.38,,,287.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,184.38,
HC PR 29450 APPLICATION OF LEG CAST,Px00096910895,CDM,29450,CPT,983,RC,,,,BOTH,,,335,301.5,187.6,,,301.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.11,,,261.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.38,,,278.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.38,,,170.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.38,,,278.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.58,,,170.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.46,,,301.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.25,,,321.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.2,,,261.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.2,,,261.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.95,,,308.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.48,,,170.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.95,,,284.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,187.6,,,301.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.5,,,318.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.2,,,109.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,109.2,184.5,
HC CUFF TOURNIQUET DISPOSABLE 18 IN SINGLE BLADDER,Sx60-7075-103,CDM,,,270,RC,,,,BOTH,,,193.03,173.73,183.38,,,173.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.56,,,150.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.73,,,160.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.73,,,98.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.73,,,160.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.58,,,98.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173.73,,,173.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.31,,,185.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.88,,,150.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,95.53,,,150.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.59,,,177.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.58,,,98.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.08,,,164.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.38,,,173.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.73,,,183.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,94.58,,,94.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,150.56,185.31,
HC SAM PELVIC II SLING X-SMALL 24 IN-27,Sx00000563497,CDM,L2580,HCPCS,274,RC,,,,BOTH,,,194.4,174.96,184.68,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.63,,,151.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,161.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,99.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,161.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,99.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.62,,,186.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.88,,,151.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.21,,,151.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.85,,,178.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,99.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.24,,,165.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.68,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,184.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,95.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,151.63,186.62,
HC SAM PELVIC II SLING LARGE 36-60,Sx00000563499,CDM,L2580,HCPCS,274,RC,,,,BOTH,,,194.4,174.96,184.68,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.63,,,151.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,161.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,99.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,161.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,99.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.62,,,186.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.88,,,151.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.21,,,151.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.85,,,178.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,99.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.24,,,165.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.68,,,174.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.96,,,184.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.26,,,95.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,151.63,186.62,
HC FOAM VAC SIMPLACE,Px00009423WNH,CDM,,,270,RC,,,,BOTH,,,194.65,175.19,184.92,,,175.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.83,,,151.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,162.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,99.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,162.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.38,,,99.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,175.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.86,,,186.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.07,,,151.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.33,,,151.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.08,,,179.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.38,,,99.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.45,,,165.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.92,,,175.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,184.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.38,,,95.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,151.83,186.86,
ACETYLCYSTEINE INJ 200 MG/ML,Rx55150025930,CDM,J0132,HCPCS,636,RC,55150025930,NDC,,BOTH,1,ML,195,175.69,185.25,,,185.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,,,152.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,143.33,,,143.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,179.4,,,179.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.75,,,165.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,185.25,,,185.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC ASSAY OF ESTRADIOL #,Px00030100136,CDM,82670,CPT,300,RC,,,,BOTH,,,195,175.5,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.1,,,152.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,99.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.51,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.4,,,179.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.75,,,165.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,185.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC ASSAY OF ESTRADIOL #,Px00030100138,CDM,82670,CPT,300,RC,,,,BOTH,,,195,175.5,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.1,,,152.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,99.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.51,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.4,,,179.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.75,,,165.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,185.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC ASSAY OF ESTRADIOL #,Px00030100596,CDM,82670,CPT,300,RC,,,,BOTH,,,195,175.5,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.1,,,152.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,99.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.51,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.4,,,179.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.75,,,165.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,185.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC ESTRADIOL,Px00030014796,CDM,82670,CPT,300,RC,,,,BOTH,,,195,175.5,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.1,,,152.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,99.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,162.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.51,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.4,,,179.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,99.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.75,,,165.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,175.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,185.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,95.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC XR DXA BONE DENSITY STUDY AXIAL,Px00032010344,CDM,77080,CPT,320,RC,,,,BOTH,,,320,175.5,185.25,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.1,,,249.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,265.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,265.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,163.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,307.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.33,,,249.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,96.51,,,249.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.4,,,294.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,163.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.75,,,272,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.5,,,304,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,95.55,,,156.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.1,187.2,
HC PR ED 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM,Px00098110511,CDM,16025,CPT,981,RC,,,,OUTPATIENT,,,261,234.9,146.16,,,234.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.09,,,203.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.13,,,217.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.13,,,133.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.13,,,217.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.52,,,133.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.86,,,234.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.55,,,250.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.28,,,203.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.28,,,203.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.77,,,240.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.53,,,133.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.77,,,221.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,146.16,,,234.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.1,,,247.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.28,,,108.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,108.28,188.1,
HC PROCALCITONIN,Px00030013086,CDM,84145,CPT,300,RC,,,,BOTH,,,196,176.4,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,99.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.06,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.32,,,180.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,186.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,96.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.88,188.16,
HC VITAMIN B-6 LEVEL,Px00030016188,CDM,84207,CPT,300,RC,,,,BOTH,,,196,176.4,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,99.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.06,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.32,,,180.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,186.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,96.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.88,188.16,
HC XR RIBS/CHEST BILAT,Px00032010049,CDM,71111,CPT,320,RC,,,,BOTH,,,196,176.4,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,99.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,163.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.06,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.32,,,180.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,99.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,186.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.04,,,96.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,152.88,188.16,
HC HEIMLICH CHEST DRAIN VALVE,Px00000407WNH,CDM,,,270,RC,,,,BOTH,,,196.65,176.99,186.82,,,176.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.39,,,153.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.99,,,163.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.99,,,100.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.99,,,163.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.36,,,100.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.99,,,176.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.78,,,188.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.54,,,153.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.32,,,153.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.92,,,180.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.36,,,100.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.15,,,167.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.82,,,176.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.99,,,186.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.36,,,96.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,153.39,188.78,
HC CHLAMYDIA TRACHOMATIS PCR,Px00030011572,CDM,87491,CPT,300,RC,,,,BOTH,,,197,177.3,187.15,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.66,,,153.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,163.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,100.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,163.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,100.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.12,,,189.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.8,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.24,,,181.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,100.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.45,,,167.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.15,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,187.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,96.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,153.66,189.12,
HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,Px00030211006,CDM,87591,CPT,300,RC,,,,BOTH,,,197,177.3,187.15,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,153.66,,,153.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,163.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,100.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,163.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,100.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.12,,,189.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,144.8,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.5,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.24,,,181.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,100.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.45,,,167.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.15,,,177.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.3,,,187.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.53,,,96.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,153.66,189.12,
HC K-WIRE W/ 17MM STOP,Sx00056-40281,CDM,,,270,RC,,,,BOTH,,,197.7,177.93,187.82,,,177.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.21,,,154.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.93,,,164.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.93,,,100.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.93,,,164.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.87,,,100.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.93,,,177.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.79,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.31,,,154.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.84,,,154.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.88,,,181.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.87,,,100.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.05,,,168.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.82,,,177.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.93,,,187.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.87,,,96.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.21,189.79,
HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099U#,Px00030610075,CDM,87486,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,Px00030610677,CDM,87491,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099U#,Px00030610077,CDM,87581,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC N.GONORRHOEAE DNA AMPLIFIED PROBE,Px00030610129,CDM,87591,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,Px00030600428,CDM,87591,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC SMR PRIM SRC WET MOUNT NFCT AGT #,Px00030011759,CDM,87653,CPT,300,RC,,,,BOTH,,,197.91,178.12,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.37,,,154.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,100.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,164.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.99,,,189.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.46,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.95,,,154.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.08,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,100.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.22,,,168.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.01,,,178.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.12,,,188.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,96.98,,,96.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.37,189.99,
HC US RETROPERITONEAL LIMITED,Px00040210011,CDM,76775,CPT,402,RC,,,,BOTH,,,198,178.2,188.1,,,178.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.44,,,154.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,164.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,100.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,164.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.02,,,100.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,178.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.08,,,190.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.53,,,154.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.99,,,154.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.16,,,182.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.02,,,100.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.3,,,168.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.1,,,178.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.2,,,188.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.02,,,97.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,154.44,190.08,
SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ),Rx00024279201,CDM,J2916,HCPCS,636,RC,24279201,NDC,,BOTH,1,ML,198.95,179.06,189,,,189,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,155.18,,,155.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,179.06,,,179.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,179.06,,,179.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,179.06,,,179.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.49,,,97.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,179.06,,,179.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,190.99,,,190.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,146.23,,,146.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,97.49,,,97.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,183.03,,,183.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.49,,,97.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,169.11,,,169.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,189,,,189,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,179.06,,,179.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,97.49,,,97.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,155.18,190.99,
SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ),Rx00024279410,CDM,J2916,HCPCS,636,RC,24279410,NDC,,BOTH,1,ML,199.83,179.85,189.84,,,179.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.87,,,155.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.85,,,166.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.85,,,101.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.85,,,166.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,101.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.85,,,179.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.84,,,191.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.88,,,155.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,155.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.84,,,183.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,101.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.86,,,169.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.84,,,179.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.85,,,189.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,97.92,,,97.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,155.87,191.84,
HC K-WIRE 1.6X200 MM,Sx0AR-5050K-1,CDM,,,270,RC,,,,BOTH,,,200,180,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156,,,156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,101.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192,,,192,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.98,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,184,,,184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170,,,170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,156,192,
HC TROCAR WIRE SINGLE 1.6X150MM,Sx00044112008,CDM,,,270,RC,,,,BOTH,,,200,180,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156,,,156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,101.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192,,,192,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.98,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,184,,,184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170,,,170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,156,192,
HC LAVAGE GASTRIC A/PED 18F CODE BLUE EASI-LAVAGE,Sx00000001518,CDM,,,270,RC,,,,BOTH,,,200,180,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156,,,156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,101.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,166.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192,,,192,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,98.98,,,156,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,184,,,184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,101.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170,,,170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190,,,180,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180,,,190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98,,,98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,156,192,
HC STAPLER LINEAR RELOAD TITANIUM HEAVY WIRE 60MM,Sx000000TRH60,CDM,,,270,RC,,,,BOTH,,,200.89,180.8,190.85,,,180.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.69,,,156.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.8,,,167.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.8,,,102.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.8,,,167.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.44,,,102.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.8,,,180.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.85,,,192.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.65,,,156.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.42,,,156.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,184.82,,,184.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.44,,,102.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.76,,,170.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.85,,,180.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.8,,,190.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.44,,,98.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,156.69,192.85,
HC ORTHOTIC/PROSTH MGMT & TRAINING SBSQ ENCTR PER 15MIN,Px00042010003,CDM,97763,CPT,420,RC,,,,BOTH,,,201,180.9,190.95,,,180.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.78,,,156.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.9,,,167.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.9,,,102.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.9,,,167.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.49,,,102.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.9,,,180.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.96,,,192.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.74,,,156.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.47,,,156.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,184.92,,,184.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.49,,,102.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.85,,,170.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.95,,,180.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.9,,,190.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.49,,,98.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,156.78,192.96,
HC PR ED 64421 INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL CDM,Px00098110816,CDM,64421,CPT,981,RC,,,,OUTPATIENT,,,370,333,207.2,,,333,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,30.7,,,288.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.25,,,307.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.25,,,188.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.25,,,307.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,27.28,,,188.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.46,,,333,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.5,,,355.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.72,,,288.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23.72,,,288.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.9,,,340.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.43,,,188.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.9,,,314.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.2,,,333,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.05,,,351.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,23.72,,,23.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,23.72,193.05,
HC PACKING NASAL POPE POSTERIOR (TAMPON),Sx00000400406,CDM,,,270,RC,,,,BOTH,,,201.5,181.35,191.43,,,181.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.17,,,157.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.35,,,167.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.35,,,102.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.35,,,167.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.74,,,102.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.35,,,181.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.44,,,193.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.1,,,157.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.72,,,157.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.38,,,185.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.74,,,102.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171.28,,,171.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.43,,,181.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.35,,,191.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.74,,,98.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,157.17,193.44,
HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM,Px00098110234,CDM,10120,CPT,981,RC,,,,OUTPATIENT,,,246,221.4,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.75,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,232.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,232.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.98,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.61,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.3,,,139.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.2,,,191.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.2,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,226.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.36,,,125.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,209.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.5,,,233.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.2,,,105.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,105.2,193.5,
HC LAVAGE GASTRIC 34F ADULT 0,Sx00000001534,CDM,,,270,RC,,,,BOTH,,,201.68,181.51,191.6,,,181.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.31,,,157.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.51,,,167.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.51,,,102.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.51,,,167.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.82,,,102.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.51,,,181.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.61,,,193.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.23,,,157.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,99.81,,,157.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.55,,,185.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.82,,,102.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171.43,,,171.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.6,,,181.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.51,,,191.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,98.82,,,98.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,157.31,193.61,
HC POUCH SPECIMEN RETRIEVAL,Sx000000POUCH,CDM,,,270,RC,,,,BOTH,,,202.3,182.07,192.19,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.79,,,157.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.07,,,168.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.07,,,103.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.07,,,168.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.13,,,103.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.07,,,182.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.21,,,194.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.69,,,157.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.12,,,157.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.12,,,186.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.13,,,103.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,171.96,,,171.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.19,,,182.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.07,,,192.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.13,,,99.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,157.79,194.21,
HC SAW BLADE 12 X 76 X 1.0 RECIP,Sx12076100SRT,CDM,,,270,RC,,,,BOTH,,,202.5,182.25,192.38,,,182.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.95,,,157.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,168.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,103.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,168.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,182.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.4,,,194.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.84,,,157.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.22,,,157.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.13,,,172.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.38,,,182.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,192.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,99.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,157.95,194.4,
HC SAW BLADE 13 X 90 X 1.19 OSCIL NARROW,Sx13090119YF1,CDM,,,270,RC,,,,BOTH,,,202.5,182.25,192.38,,,182.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,157.95,,,157.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,168.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,103.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,168.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,182.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.4,,,194.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.84,,,157.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.22,,,157.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,103.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.13,,,172.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.38,,,182.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.25,,,192.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.23,,,99.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,157.95,194.4,
HC CANDIDA ANTIBODY,Px00030010736,CDM,86628,CPT,300,RC,,,,BOTH,,,203.22,182.9,193.06,,,182.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.51,,,158.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,169.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,103.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,169.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.58,,,103.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,182.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.09,,,195.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.37,,,158.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.57,,,158.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.96,,,186.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.58,,,103.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.74,,,172.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.06,,,182.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,193.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.58,,,99.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,158.51,195.09,
HC PR 27570 MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,Px00097511330,CDM,27570,CPT,975,RC,,,,BOTH,,,360,324,201.6,,,324,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.63,,,280.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225,,,298.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225,,,178.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225,,,298.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.99,,,178.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,179.5,,,324,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198,,,203.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,280.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,331.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.31,,,183.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,306,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,324,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.3,,,342,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,349.74,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,349.74,195.3,
HC PERCUTANEOUS INTRODUCER KIT KIT W/SYRING & DRESSING,SxUC-098000-S,CDM,,,270,RC,,,,BOTH,,,203.5,183.15,193.33,,,183.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.73,,,158.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.15,,,169.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.15,,,103.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.15,,,169.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.72,,,103.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.15,,,183.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.36,,,195.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.57,,,158.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.71,,,158.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.22,,,187.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.72,,,103.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.98,,,172.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.33,,,183.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.15,,,193.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.72,,,99.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,158.73,195.36,
HC NASAL PAC RHINO 7.5 GEL RAPID RHINO NASAL TAMPON,Sx00000000750,CDM,,,270,RC,,,,BOTH,,,203.78,217.22,193.59,,,183.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.95,,,158.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.4,,,169.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.4,,,103.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.4,,,169.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.85,,,103.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.4,,,183.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.63,,,195.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.78,,,158.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.85,,,158.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.48,,,187.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.85,,,103.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173.21,,,173.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.59,,,183.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.4,,,193.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,99.85,,,99.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,158.95,195.63,
HC PR 64488 TAP BLOCK BI INJECTION,Px00096310279,CDM,64488,CPT,963,RC,,,,BOTH,,,160,144,89.6,,,144,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.72,,,124.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100,,,133.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100,,,81.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100,,,133.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.2,,,81.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.68,,,144,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,153.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.4,,,124.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,75.2,,,124.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.95,,,147.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76,,,81.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.2,,,136,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.6,,,144,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.64,,,152,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.37,,,80.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,75.2,196.64,
HC SPECIMEN RADIOGRAPHY DEVICE BIOPSY,Sx6001-01 839,CDM,,,270,RC,,,,BOTH,,,205.6,107.87,195.32,,,185.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.37,,,160.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.04,,,171.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.04,,,104.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.04,,,171.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.74,,,104.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.04,,,185.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.38,,,197.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,151.12,,,160.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,101.75,,,160.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.15,,,189.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.74,,,104.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.76,,,174.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.32,,,185.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.04,,,195.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,100.74,,,100.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,160.37,197.38,
HC TESTOSTERONE,Px00030112336,CDM,84403,CPT,300,RC,,,,BOTH,,,207,186.3,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,105.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.15,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.44,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.44,,,190.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.95,,,175.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,196.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,161.46,198.72,
HC ASSAY OF TESTOSTERONE TOTAL #,Px00030100655,CDM,84403,CPT,300,RC,,,,BOTH,,,207,186.3,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,105.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.15,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.44,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.44,,,190.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.95,,,175.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,196.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,161.46,198.72,
HC ASSAY OF TESTOSTERONE TOTAL #,Px00030100656,CDM,84403,CPT,300,RC,,,,BOTH,,,207,186.3,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,105.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.15,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.44,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.44,,,190.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.95,,,175.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,196.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,161.46,198.72,
HC ASSAY OF TESTOSTERONE TOTAL #,Px00030100657,CDM,84403,CPT,300,RC,,,,BOTH,,,207,186.3,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,105.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.15,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.44,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.44,,,190.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.95,,,175.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,196.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,161.46,198.72,
HC TESTOSTERONE TOTAL,Px00030112115,CDM,84403,CPT,300,RC,,,,BOTH,,,207,186.3,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.46,,,161.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,105.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,172.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.15,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.44,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.44,,,190.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,105.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.95,,,175.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.65,,,186.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.3,,,196.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.43,,,101.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,161.46,198.72,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx43825010201,CDM,J0131,HCPCS,636,RC,43825010201,NDC,,BOTH,1,ML,207.96,187.16,197.56,,,197.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,162.21,,,162.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,199.64,,,199.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.85,,,152.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.32,,,191.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,176.77,,,176.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,197.56,,,197.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,162.21,199.64,
ACETAMINOPHEN IV SOLN 10 MG/ML,Rx43825010201,CDM,J0131,HCPCS,636,RC,43825010201,NDC,,BOTH,1,ML,207.96,287.96,197.56,,,197.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,162.21,,,162.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,199.64,,,199.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.85,,,152.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.32,,,191.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,176.77,,,176.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,197.56,,,197.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,187.16,,,187.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,101.9,,,101.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,162.21,199.64,
HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR,Px00039010045,CDM,P9059,CPT,390,RC,,,,BOTH,,,208,160.2,197.6,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.24,,,162.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,173.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,173.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.92,,,106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.68,,,199.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,162.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.94,,,162.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.36,,,191.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.92,,,106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.8,,,176.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.6,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,197.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,101.92,,,101.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,162.24,199.68,
HC PR 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES CDM,Px00098710006,CDM,99222,CPT,987,RC,,,,BOTH,,,314,282.6,175.84,,,282.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.93,,,244.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.25,,,261.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.25,,,160.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.25,,,261.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.97,,,160.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,282.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.7,,,301.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,244.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,244.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.98,,,288.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.84,,,160.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.98,,,266.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.84,,,282.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,298.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,201.25,
HC SUTURETAPE 1.7MM W/TAILS WHITE/BLUE,Sx0000AR-7511,CDM,,,270,RC,,,,BOTH,,,210,165.38,199.5,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,143.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,152.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,93.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,152.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,93.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,176.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,143.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.93,,,143.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.2,,,169.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,93.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.5,,,156.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,165.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,174.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,102.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,163.8,201.6,
HC BB TAK,Sx000AR-13226,CDM,,,270,RC,,,,BOTH,,,210,189,199.5,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,174.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,107.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,174.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,107.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,201.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.93,,,163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.2,,,193.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,107.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.5,,,178.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,199.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,102.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,163.8,201.6,
HC SUTURETAPE TIGERLOOP W/NDL WH/BL,Sx000AR-7534T,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,210,189,199.5,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,174.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,107.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,174.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,107.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,201.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.93,,,163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.2,,,193.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,107.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.5,,,178.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,189,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189,,,199.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,102.9,,,102.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,163.8,201.6,
HC CATH STAMEY SUPRAPUBIC 14FR,Sx00000081014,CDM,,,270,RC,,,,BOTH,,,210.6,189.54,200.07,,,189.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.27,,,164.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,175.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,107.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,175.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.19,,,107.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,189.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.18,,,202.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.79,,,164.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.23,,,164.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.75,,,193.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.19,,,107.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.01,,,179.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.07,,,189.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,200.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.19,,,103.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.27,202.18,
HC SCREW 2.4X18MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx0000201.768,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC SCREW 2.4X20MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx00000201.77,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC SCREW 2.4X24MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx0000201.774,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC SCREW 2.4X28MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx0000201.778,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC SCREW 2.4X30MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx00000201.78,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC SCREW.2.4X38MM CORTEX SELF-TAP T8 STAR DR RECESS IMP,Sx0000201.788,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,211.5,190.35,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.97,,,164.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,107.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,176.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.04,,,203.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.45,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.67,,,164.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.58,,,194.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,107.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.78,,,179.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,190.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.64,,,103.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,164.97,203.04,
HC PR ED 11982 REMOVE DRUG IMPLANT DEVICE CDM,Px00098110052,CDM,11982,CPT,981,RC,,,,OUTPATIENT,,,279,251.1,156.24,,,251.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93.52,,,217.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.38,,,255.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.38,,,255.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.66,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.4,,,251.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.45,,,132.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.14,,,217.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.14,,,217.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.03,,,256.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.24,,,142.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.03,,,237.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.24,,,251.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.41,,,265.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.14,,,70.14,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.14,203.41,
HC BLOOD TYPING PATIENT SERUM,Px00030011111,CDM,86904,CPT,300,RC,,,,BOTH,,,212,190.8,201.4,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.36,,,165.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,176.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,108.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,176.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,108.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.52,,,203.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.82,,,165.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.92,,,165.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.04,,,195.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,108.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.2,,,180.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.4,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,201.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,103.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.36,203.52,
HC XR HIPS BIL W PELVIS 3-4 VIEWS,Px00032010612,CDM,73522,CPT,320,RC,,,,BOTH,,,212,190.8,201.4,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.36,,,165.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,176.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,108.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,176.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,108.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.52,,,203.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.82,,,165.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.92,,,165.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.04,,,195.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,108.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.2,,,180.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.4,,,190.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.8,,,201.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.88,,,103.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.36,203.52,
HC LENS MORGAN MEDI-FLOW LENS,Px00001105WNH,CDM,,,270,RC,,,,BOTH,,,212.12,190.91,201.51,,,190.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.45,,,165.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.91,,,176.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.91,,,108.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.91,,,176.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.94,,,108.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.91,,,190.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.64,,,203.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.91,,,165.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.98,,,165.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.15,,,195.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.94,,,108.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.3,,,180.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.51,,,190.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.91,,,201.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,103.94,,,103.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.45,203.64,
HC SAW BLADE 25 X 90 X 1.19 OSCIL WIDE,Sx25090119YG1,CDM,,,270,RC,,,,BOTH,,,212.4,191.16,201.78,,,191.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.67,,,165.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.16,,,176.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.16,,,108.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.16,,,176.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.08,,,108.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.16,,,191.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.9,,,203.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.11,,,165.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,105.12,,,165.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.41,,,195.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.08,,,108.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,180.54,,,180.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.78,,,191.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.16,,,201.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,104.08,,,104.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.67,203.9,
HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM,Px00098110812,CDM,62270,CPT,981,RC,,,,OUTPATIENT,,,143,128.7,80.08,,,128.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,111.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.38,,,119.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.38,,,72.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.38,,,119.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.7,,,72.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93,,,128.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.65,,,137.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,111.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,111.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.51,,,131.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.32,,,72.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.51,,,121.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.08,,,128.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.3,,,135.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,61.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,61.48,204.3,
HC PR 62270 ANES/SPINAL PUNC,Px00096310224,CDM,62270,CPT,975,RC,,,,BOTH,,,363,326.7,203.28,,,326.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,283.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.88,,,302.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.88,,,184.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.88,,,302.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.7,,,184.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93,,,326.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.65,,,348.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,283.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,283.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.91,,,333.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.32,,,184.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.91,,,308.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.28,,,326.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.3,,,344.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,61.48,,,61.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,61.48,204.3,
HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC  CDM,Px00097514105,CDM,62270,CPT,963,RC,,,,BOTH,,,318,286.2,178.08,,,286.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.69,,,248.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.75,,,264.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.75,,,162.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.75,,,264.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.46,,,162.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,93,,,286.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.93,,,305.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.72,,,248.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.46,,,248.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.93,,,292.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,151.05,,,162.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.26,,,270.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.08,,,286.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.3,,,302.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,59.22,,,59.22,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,149.46,204.3,
HC PR ED 12005 REPAIR SUPERFIC WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN CDM,Px00098110262,CDM,12005,CPT,981,RC,,,,OUTPATIENT,,,226,203.4,126.56,,,203.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.77,,,176.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.25,,,188.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.25,,,115.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.25,,,188.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.24,,,115.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.07,,,203.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.3,,,216.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.77,,,176.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.77,,,176.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.82,,,207.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.46,,,115.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.82,,,192.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.56,,,203.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.66,,,214.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.77,,,89.77,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,89.77,205.66,
HC PR ED 12015 REPAIR SUPERFIC WOUND(S) 7.6 TO 12.5CM FACE ERS EYLD NS CDM,Px00098110268,CDM,12015,CPT,981,RC,,,,OUTPATIENT,,,223,200.7,124.88,,,200.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.26,,,173.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.38,,,185.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.38,,,113.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.38,,,185.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.75,,,113.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.8,,,200.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.65,,,214.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.35,,,173.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,89.35,,,173.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.11,,,205.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.03,,,113.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.11,,,189.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.88,,,200.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.09,,,211.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.35,,,89.35,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,89.35,206.09,
HC PR ED 10140 DRAINAGE OF HEMATOMA/FLUID CDM,Px00098110236,CDM,10140,CPT,981,RC,,,,OUTPATIENT,,,981,882.9,549.36,,,882.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.56,,,765.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,613.13,,,750.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,613.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,613.13,,,750.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.48,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.22,,,882.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,539.55,,,159.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.81,,,765.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.81,,,765.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,559.17,,,902.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.34,,,499.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,559.17,,,833.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,549.36,,,882.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.9,,,931.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.81,,,117.81,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,117.81,207.9,
HC PR ED 42000 DRAINAGE MOUTH ROOF LESION CDM,Px00098110361,CDM,42000,CPT,981,RC,,,,OUTPATIENT,,,426,383.4,238.56,,,383.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.48,,,332.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.25,,,354.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.25,,,217.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.25,,,354.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.28,,,217.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.51,,,383.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.3,,,408.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.94,,,332.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.94,,,332.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,242.82,,,391.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.21,,,217.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,242.82,,,362.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,238.56,,,383.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.34,,,404.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.94,,,108.94,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,108.94,208.34,
HC PR ED 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP CDM,Px00098110448,CDM,28515,CPT,981,RC,,,,OUTPATIENT,,,573,515.7,320.88,,,515.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.78,,,446.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.13,,,476.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.13,,,292,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.13,,,476.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.99,,,292,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.02,,,515.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.15,,,550.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.82,,,446.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.82,,,446.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,326.61,,,527.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.25,,,292,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,326.61,,,487.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,320.88,,,515.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.34,,,544.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.82,,,147.82,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,147.82,208.34,
HC HOLTER MONITOR UP TO 48 HRS,Px00073110001,CDM,93225,CPT,731,RC,,,,BOTH,,,218,196.2,207.1,,,196.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.04,,,170.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.2,,,181.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.2,,,111.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.2,,,181.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.82,,,111.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.2,,,196.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.28,,,209.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,170.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,106.82,,,170.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.56,,,200.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.82,,,111.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.3,,,185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.1,,,196.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.2,,,207.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.82,,,106.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.04,209.28,
HC SUCTION IRRIGATOR 0,Sx00250070500,CDM,,,270,RC,,,,BOTH,,,218.33,196.5,207.41,,,196.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.3,,,170.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.5,,,181.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.5,,,111.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.5,,,181.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,111.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.5,,,196.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.6,,,209.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.47,,,170.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.05,,,170.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.86,,,200.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,111.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.58,,,185.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.41,,,196.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.5,,,207.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,106.98,,,106.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.3,209.6,
HC SCREW BONE T10 3.5X32MM IMPLNT,Sx00040-35032,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,218.4,196.56,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.35,,,170.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,111.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.66,,,209.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.09,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.64,,,185.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,207.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,107.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.35,209.66,
HC SCREW BONE T10 3.5X34MM IMPLNT,Sx00040-35034,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,218.4,196.56,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.35,,,170.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,111.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.66,,,209.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.09,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.64,,,185.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,207.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,107.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.35,209.66,
HC SCREW BONE T10 3.5X12MM IMPLNT,Sx00040-35012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,218.4,196.56,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.35,,,170.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,111.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,181.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.66,,,209.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.09,,,170.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,200.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,111.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.64,,,185.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.48,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,207.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.02,,,107.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.35,209.66,
NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY),Rx45802021001,CDM,,,250,RC,45802-0210-01,NDC,,BOTH,0.4,ME,219.05,197.15,208.1,,,392.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.86,,,339.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.15,,,362.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.15,,,222.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.15,,,362.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.33,,,222.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.15,,,392.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.29,,,418.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161,,,339.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.41,,,339.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.53,,,400.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.33,,,222.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.19,,,370.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.1,,,392.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.15,,,414.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.33,,,107.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,170.86,210.29,
HC PR 11402 EXC TR-EXT B9+MARG 1.1-2 CM,Px00097510068,CDM,11402,CPT,975,RC,,,,BOTH,,,410,369,229.6,,,369,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.9,,,319.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.25,,,347.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.25,,,347.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.42,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.53,,,369,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.5,,,153.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,319.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,319.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,233.7,,,377.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.6,,,208.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,233.7,,,348.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,229.6,,,369,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.59,,,389.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,115.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,115.15,210.59,
HC DISSECTOR CYRVED 4.0MM X 13CM,Sx0AR-8400CDS,CDM,,,270,RC,,,,BOTH,,,220,198,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.6,,,171.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,112.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.2,,,211.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.88,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.4,,,202.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187,,,187,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,209,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,107.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,171.6,211.2,
HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES #,Px00030100627,CDM,83704,CPT,300,RC,,,,BOTH,,,220,198,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.6,,,171.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,112.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.2,,,211.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.88,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.4,,,202.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187,,,187,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,209,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,107.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,171.6,211.2,
HC LIPOPROTEIN BLD BY NMR,Px00030013080,CDM,83704,CPT,300,RC,,,,BOTH,,,220,198,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.6,,,171.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,112.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.2,,,211.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.88,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.4,,,202.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187,,,187,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,209,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,107.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,171.6,211.2,
HC PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA,Px00030210878,CDM,86970,CPT,300,RC,,,,BOTH,,,220,198,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.6,,,171.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,112.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,183.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.2,,,211.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.88,,,171.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.4,,,202.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,112.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187,,,187,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209,,,198,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198,,,209,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,107.8,,,107.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,171.6,211.2,
HC SUTURETAPE FIBERLOOP W/NDL WH/BL,Sx0000AR-7534,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,220.5,198.45,209.48,,,198.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.99,,,171.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,183.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,112.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,183.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.05,,,112.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,198.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.07,,,171.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.13,,,171.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,202.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.05,,,112.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.43,,,187.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.48,,,198.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,209.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.05,,,108.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,171.99,211.68,
HC STRAP FOOT ANKLE DISTRACTOR STERILE,Sx00000014407,CDM,,,270,RC,,,,BOTH,,,220.8,182.34,209.76,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.22,,,172.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,183.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,112.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,183.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.19,,,112.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.97,,,211.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,172.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,172.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.14,,,203.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.19,,,112.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.68,,,187.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,198.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.72,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.19,,,108.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,172.22,211.97,
HC OT RE-EVALUATION ESTABLISHED PLAN OF CARE,Px00043410048,CDM,97168,CPT,434,RC,,,,BOTH,,,221,198.9,209.95,,,198.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.38,,,172.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,183.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,112.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,183.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.29,,,112.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,198.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.16,,,212.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.44,,,172.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.37,,,172.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.32,,,203.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.29,,,112.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.85,,,187.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.95,,,198.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,209.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.29,,,108.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,172.38,212.16,
HC LINEAR RELOAD CUTTER TITANIUM THICK TISSUE 77MM,Sx000000TRT75,CDM,,,270,RC,,,,BOTH,,,221.81,202.84,210.72,,,202.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.01,,,175.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.63,,,187.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.63,,,114.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.63,,,187.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.69,,,114.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.63,,,202.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.94,,,216.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.03,,,175.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.77,,,175.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.07,,,207.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.69,,,114.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.54,,,191.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.72,,,202.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.63,,,214.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.69,,,108.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.01,212.94,
HC ED FAC E&M VISIT LEVEL 1 CDM,Px00045010204,CDM,99281,CPT,450,RC,,,,OUTPATIENT,,,222,157.5,210.9,,,173.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.16,,,150.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,160.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,98.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,160.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,98.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,173.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,185.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,150.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.87,,,150.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.24,,,177.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,98.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.7,,,164.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.9,,,173.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,183.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,108.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.16,213.12,
HC IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,Px00030610056,CDM,87651,CPT,300,RC,,,,BOTH,,,222,199.8,210.9,,,199.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.16,,,173.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,184.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,113.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,184.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,113.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,199.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,213.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,173.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.87,,,173.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.24,,,204.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,113.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.7,,,188.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.9,,,199.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.8,,,210.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,108.78,,,108.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.16,213.12,
HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY,Px00097510758,CDM,45330,CPT,975,RC,,,,BOTH,,,130,117,72.8,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.57,,,101.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,108.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.25,,,108.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.97,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.97,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,71.5,,,124.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.63,,,101.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,55.63,,,101.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,119.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,57.3,,,66.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.1,,,110.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.8,,,117,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.3,,,123.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,55.63,,,55.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,55.63,213.3,
HC ASSAY OF THEOPHYLLINE,Px00030112071,CDM,80198,CPT,300,RC,,,,BOTH,,,223,200.7,211.85,,,200.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.94,,,173.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,185.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,113.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,185.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,113.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,200.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.08,,,214.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,173.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.36,,,173.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,205.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,113.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.55,,,189.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.85,,,200.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,211.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,109.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.94,214.08,
HC SPINE LUMBOSACRAL MIN 4 VIEWS,Px00032010066,CDM,72110,CPT,320,RC,,,,BOTH,,,300,200.7,211.85,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.94,,,234,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,249,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,153,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,249,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,153,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.08,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.36,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,276,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,153,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.55,,,255,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.85,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.7,,,285,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.27,,,147,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.94,214.08,
HC TOURNIQUET TACTICAL BLK 1 1/2,Px00011009WNH,CDM,,,270,RC,,,,BOTH,,,223.05,200.75,211.9,,,200.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.98,,,173.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.75,,,185.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.75,,,113.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.75,,,185.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.29,,,113.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.75,,,200.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.13,,,214.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.94,,,173.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.39,,,173.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.21,,,205.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.29,,,113.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.59,,,189.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.9,,,200.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.75,,,211.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.29,,,109.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,173.98,214.13,
"ALBUMIN, HUMAN INJ 25%",Rx44206025191,CDM,P9047,HCPCS,636,RC,44206025191,NDC,,BOTH,20,ML,223.08,200.77,211.93,,,211.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,174,,,174,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,200.77,,,200.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,200.77,,,200.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,200.77,,,200.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,109.31,,,109.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,200.77,,,200.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.16,,,214.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,163.96,,,163.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,109.31,,,109.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.23,,,205.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,109.31,,,109.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,189.62,,,189.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,211.93,,,211.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,200.77,,,200.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,109.31,,,109.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,174,214.16,
"ALBUMIN, HUMAN INJ 25%",Rx44206025110,CDM,P9047,HCPCS,636,RC,44206025110,NDC,,BOTH,20,ML,223.08,200.77,211.93,,,200.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174,,,174.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.77,,,185.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.77,,,113.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.77,,,185.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.31,,,113.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.77,,,200.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.16,,,214.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.96,,,174.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.31,,,174.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.23,,,205.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.31,,,113.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.62,,,189.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.93,,,200.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.77,,,211.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.31,,,109.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,174,214.16,
HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,Px00042410069,CDM,97164,CPT,424,RC,,,,BOTH,,,224,201.6,212.8,,,201.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.72,,,174.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,186.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,114.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,186.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.76,,,114.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,201.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.04,,,215.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,174.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,110.86,,,174.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.08,,,206.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.76,,,114.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.4,,,190.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.8,,,201.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.6,,,212.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,109.76,,,109.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,174.72,215.04,
HC SLING DISP MED LOOP FULL BACK,Sx0000NA25622,CDM,,,270,RC,,,,BOTH,,,225.5,202.95,214.23,,,202.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.89,,,175.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,187.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,114.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,187.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,114.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,202.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.48,,,216.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.74,,,175.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,175.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.46,,,207.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,114.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.68,,,191.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.23,,,202.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,214.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,175.89,216.48,
HC SLING DISP LG LOOP FULL BACK,Sx0000NA25623,CDM,,,270,RC,,,,BOTH,,,225.5,202.95,214.23,,,202.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.89,,,175.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,187.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,114.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,187.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,114.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,202.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.48,,,216.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.74,,,175.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.6,,,175.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.46,,,207.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,114.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.68,,,191.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.23,,,202.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,214.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.5,,,110.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,175.89,216.48,
HC CANISTER NEGATIVE PRESSURE FREEDOM WOUND VAC,Sx0320058/5.S,CDM,,,270,RC,,,,BOTH,,,225.92,155.39,214.62,,,203.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.22,,,176.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.33,,,188.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.33,,,115.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.33,,,188.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.7,,,115.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.33,,,203.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.88,,,216.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.05,,,176.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.81,,,176.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.85,,,207.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.7,,,115.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,192.03,,,192.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.62,,,203.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.33,,,214.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,110.7,,,110.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,176.22,216.88,
HC SCREW BONE T7 2.7X10MM IMPLNT,Sx00040-27010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,228,205.2,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.84,,,177.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,116.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,218.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.84,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.8,,,193.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,216.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,111.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.84,218.88,
HC SCREW BONE T7 2.7X12MM IMPLNT,Sx00040-27012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,228,205.2,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.84,,,177.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,116.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,218.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.84,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.8,,,193.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,216.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,111.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.84,218.88,
HC SCREW BONE T7 2.7X14MM IMPLNT,Sx00040-27014,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,228,205.2,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.84,,,177.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,116.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,218.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.84,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.8,,,193.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,216.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,111.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.84,218.88,
HC SCREW BONE T7 2.7X20MM IMPLNT,Sx00040-27020,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,228,205.2,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.84,,,177.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,116.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,218.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.84,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.8,,,193.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,216.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,111.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.84,218.88,
HC SCREW BONE T7 2.7X24MM IMPLNT,Sx00040-27024,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,228,205.2,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.84,,,177.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,116.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,189.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,218.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,112.84,,,177.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.76,,,209.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,116.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.8,,,193.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.6,,,205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.2,,,216.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,111.72,,,111.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.84,218.88,
"ALBUMIN, HUMAN INJ 25%",Rx76125079210,CDM,P9047,HCPCS,636,RC,76125079210,NDC,,BOTH,20,ML,228.82,205.94,217.38,,,217.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,178.48,,,178.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.94,,,205.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.94,,,205.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.94,,,205.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.12,,,112.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.94,,,205.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,219.67,,,219.67,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,168.18,,,168.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,112.12,,,112.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,210.51,,,210.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.12,,,112.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,194.5,,,194.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,217.38,,,217.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.94,,,205.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,112.12,,,112.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,178.48,219.67,
HC DRESSING GRANU MED,Px00009580WNH,CDM,,,270,RC,,,,BOTH,,,228.85,205.97,217.41,,,205.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.5,,,178.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.97,,,190.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.97,,,116.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.97,,,190.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.14,,,116.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.97,,,205.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.7,,,219.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.2,,,178.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.26,,,178.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,210.54,,,210.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.14,,,116.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.52,,,194.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.41,,,205.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.97,,,217.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.14,,,112.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,178.5,219.7,
HC ASSAY OF ALDOSTERONE,Px00030112152,CDM,82088,CPT,300,RC,,,,BOTH,,,229.83,206.85,218.34,,,206.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.27,,,179.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.85,,,191.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.85,,,117.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.85,,,191.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,117.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.85,,,206.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.64,,,220.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,168.93,,,179.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.74,,,179.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.44,,,211.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,117.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.36,,,195.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.34,,,206.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.85,,,218.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,112.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,179.27,220.64,
HC KIT MICROINTRODUCER 5FR 10CM STAINLESS,Sx00000128950,CDM,,,270,RC,,,,BOTH,,,230.2,207.18,218.69,,,207.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.56,,,179.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.18,,,191.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.18,,,117.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.18,,,191.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.8,,,117.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.18,,,207.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.99,,,220.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.2,,,179.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.93,,,179.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.78,,,211.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.8,,,117.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.67,,,195.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.69,,,207.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.18,,,218.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,112.8,,,112.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,179.56,220.99,
HC PR 32551 INSERTION OF CHEST TUBE,Px00097500095,CDM,32551,CPT,975,RC,,,,BOTH,,,369,332.1,206.64,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.91,,,287.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,307.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,307.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.94,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.97,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,354.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,287.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,287.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.33,,,339.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.2,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.33,,,313.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.64,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,221.4,,,350.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,194.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,194.34,221.4,
HC PR ED 32551 INSERTION OF CHEST TUBE CDM,Px00098110342,CDM,32551,CPT,981,RC,,,,OUTPATIENT,,,369,332.1,206.64,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.91,,,287.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,307.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.63,,,307.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.49,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.97,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.95,,,354.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,287.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,287.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.33,,,339.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,200.17,,,188.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.33,,,313.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.64,,,332.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,221.4,,,350.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,194.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,194.34,221.4,
ACETYLCYSTEINE INJ 200 MG/ML,Rx72611086001,CDM,J0132,HCPCS,636,RC,72611086001,NDC,,BOTH,1,ML,230.85,207.77,219.31,,,219.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,180.06,,,180.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,207.77,,,207.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,207.77,,,207.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,207.77,,,207.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,113.12,,,113.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.77,,,207.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,221.62,,,221.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,169.67,,,169.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,113.12,,,113.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,212.38,,,212.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,113.12,,,113.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.22,,,196.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,219.31,,,219.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,207.77,,,207.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,113.12,,,113.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,180.06,221.62,
HC AGRESSIVE PLUS SHAVER 4MM CURVED,Sx380-544-100,CDM,,,270,RC,,,,BOTH,,,231.6,165.19,220.02,,,208.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.65,,,180.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.44,,,192.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.44,,,118.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.44,,,192.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.48,,,118.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.44,,,208.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.34,,,222.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.23,,,180.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.62,,,180.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.07,,,213.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.48,,,118.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.86,,,196.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.02,,,208.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.44,,,220.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.48,,,113.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,180.65,222.34,
HC RECOVERY CLASS I - ADDL 15 MIN,Px00071010110,CDM,,,710,RC,,,,BOTH,,,232,208.8,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.96,,,180.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,118.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.72,,,222.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.44,,,213.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.2,,,197.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,220.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,113.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,180.96,222.72,
HC GUIDE PLS A.I.M.,SxPDG-AIM-091,CDM,,,270,RC,,,,BOTH,,,232,208.8,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.96,,,180.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,118.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.72,,,222.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.82,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.44,,,213.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.2,,,197.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,220.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,113.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,180.96,222.72,
HC INSITU HYBRIDIZATION EACH ADDL - SENDOUT,Px00031010180,CDM,88364,CPT,300,RC,,,,BOTH,,,232,208.8,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.96,,,180.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,118.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,193.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.72,,,222.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.82,,,180.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.44,,,213.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,118.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.2,,,197.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.4,,,208.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.8,,,220.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,113.68,,,113.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,180.96,222.72,
HC XR HIPS UNI W PELVIS MIN 4 VIEWS,Px00032010610,CDM,73503,CPT,320,RC,,,,BOTH,,,234,210.6,222.3,,,210.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.52,,,182.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,194.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,119.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,194.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.66,,,119.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,210.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.64,,,224.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.99,,,182.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,115.81,,,182.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.28,,,215.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.66,,,119.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,198.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.3,,,210.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,222.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,114.66,,,114.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,182.52,224.64,
HC K-WIRE 2.8 X 30MM,Sx000454-0017,CDM,,,270,RC,,,,BOTH,,,235,211.5,223.25,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.3,,,183.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,195.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,119.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,195.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,119.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.6,,,225.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.73,,,183.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.3,,,183.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216.2,,,216.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,119.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.75,,,199.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.25,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,223.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,115.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,183.3,225.6,
HC GUIDE WIRE DRILL TIP 2.4,Sx000454-0016,CDM,,,270,RC,,,,BOTH,,,235,211.5,223.25,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.3,,,183.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,195.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,119.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,195.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,119.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.6,,,225.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.73,,,183.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.3,,,183.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216.2,,,216.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,119.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.75,,,199.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.25,,,211.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.5,,,223.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.15,,,115.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,183.3,225.6,
HC PR 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL  CDM,Px00097514075,CDM,46083,CPT,975,RC,,,,BOTH,,,262,235.8,146.72,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.96,,,204.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,218.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,133.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.75,,,218.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.74,,,133.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.65,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.1,,,251.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,204.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.34,,,241.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,133.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.34,,,222.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,146.72,,,235.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.9,,,248.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,109.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,109.34,225.9,
HC PR ED 46083 INCISE EXTERNAL HEMORRHOID CDM,Px00098110383,CDM,46083,CPT,981,RC,,,,OUTPATIENT,,,428,385.2,239.68,,,385.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.96,,,333.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.5,,,356.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.5,,,218.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.5,,,356.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,125.74,,,218.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.65,,,385.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.4,,,410.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,333.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,333.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.96,,,393.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.62,,,218.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.96,,,363.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.68,,,385.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.9,,,406.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.34,,,109.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,109.34,225.9,
HC THORACENTESIS KIT,Px00005788WNH,CDM,,,270,RC,,,,BOTH,,,236,212.4,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.08,,,184.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,120.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.56,,,226.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.8,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.12,,,217.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.6,,,200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,224.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,115.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.08,226.56,
HC DISSECTOR 4.0MM X 13CM,Sx00AR-8400DS,CDM,,,270,RC,,,,BOTH,,,236,212.4,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.08,,,184.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,120.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.56,,,226.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.8,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.12,,,217.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.6,,,200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,224.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,115.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.08,226.56,
HC BURR ROUND 8 FLUTE 4MM X 13C,Sx0AR-8400RBE,CDM,,,270,RC,,,,BOTH,,,236,212.4,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.08,,,184.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,120.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,196.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.56,,,226.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.8,,,184.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.12,,,217.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,120.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.6,,,200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.2,,,212.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.4,,,224.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.64,,,115.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.08,226.56,
HC COLLAGEN COATED FIBERTAPE (ORDER IN BOX IN QUANTITIES),Sx0AR-7237-7B,CDM,,,270,RC,,,,BOTH,,,236.25,212.63,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.28,,,184.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.64,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.92,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.35,,,217.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.81,,,200.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,224.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,115.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.28,226.8,
HC LO-PRO SCREW TM SS 2.7X14MM CORTEX,Sx0AR-8827-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,236.25,212.63,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.28,,,184.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.64,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.92,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.35,,,217.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.81,,,200.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,224.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,115.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.28,226.8,
HC LO-PRO SCREW TM SS 2.7X16MM CORTEX,Sx0AR-8827-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,236.25,212.63,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.28,,,184.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.64,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.92,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.35,,,217.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.81,,,200.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,224.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,115.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.28,226.8,
HC LO-PRO SCREW TM SS 2.7X22MM CORTEX,Sx0AR-8827-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,236.25,212.63,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.28,,,184.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,120.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,196.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.64,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,116.92,,,184.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.35,,,217.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,120.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.81,,,200.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.44,,,212.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.63,,,224.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,115.76,,,115.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.28,226.8,
HC K WIRE FULL THRD 1.6X200MM,Sx00045-80100,CDM,,,270,RC,,,,BOTH,,,236.8,213.12,224.96,,,213.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.7,,,184.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,197.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,120.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,197.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.03,,,120.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,213.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.33,,,227.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.05,,,184.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.19,,,184.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.86,,,217.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.03,,,120.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.28,,,201.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.96,,,213.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.12,,,224.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.03,,,116.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.7,227.33,
HYDRALAZINE HCL INJ 20 MG/ML,Rx17478093401,CDM,J0360,HCPCS,636,RC,17478093401,NDC,,BOTH,1,ML,236.97,213.27,225.12,,,225.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,184.84,,,184.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,213.27,,,213.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,213.27,,,213.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,213.27,,,213.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,116.12,,,116.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,213.27,,,213.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,227.49,,,227.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,174.17,,,174.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,116.12,,,116.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,218.01,,,218.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,116.12,,,116.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,201.42,,,201.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,225.12,,,225.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,213.27,,,213.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,116.12,,,116.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,184.84,227.49,
HC STRYKER SUCT-IRR W/CAUT,Px00007299WNH,CDM,,,270,RC,,,,BOTH,,,237.56,213.8,225.68,,,213.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.3,,,185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,197.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,121.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,197.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.4,,,121.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,213.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.06,,,228.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.61,,,185.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.57,,,185.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.56,,,218.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.4,,,121.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.93,,,201.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.68,,,213.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,225.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.4,,,116.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,185.3,228.06,
HC XR CERVICAL SPINE 6 OR MORE VIEWS,Px00032010057,CDM,72052,CPT,320,RC,,,,BOTH,,,238,214.2,226.1,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.64,,,185.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,198.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,121.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,198.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.62,,,121.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.48,,,228.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,185.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.79,,,185.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.96,,,218.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.62,,,121.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.3,,,202.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.1,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,226.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,116.62,,,116.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,185.64,228.48,
HC PR ED 10080 DRAINAGE OF PILONIDAL CYST SIMPLE CDM,Px00098110232,CDM,10080,CPT,981,RC,,,,OUTPATIENT,,,250,225,140,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.87,,,195,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,234.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,234.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.15,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.17,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.5,,,139.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.48,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,104.48,,,195,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,230,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.61,,,127.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,212.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.6,,,237.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,104.48,,,104.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,104.48,228.6,
HC PR ED 13133 REPAIR WOUND/LESION ADD ON 5CM CMPLX FRHD CKS SHN MTH NK CDM,Px00098110503,CDM,13133,CPT,981,RC,,,,OUTPATIENT,,,697,627.3,390.32,,,627.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.96,,,543.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.63,,,580.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.63,,,355.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.63,,,580.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.14,,,355.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.68,,,627.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,383.35,,,669.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.99,,,543.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.99,,,543.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.29,,,641.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.62,,,355.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.29,,,592.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.32,,,627.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.6,,,662.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.99,,,120.99,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,120.99,228.6,
HC PR 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE,Px00097511311,CDM,29826,CPT,975,RC,,,,BOTH,,,407,366.3,227.92,,,366.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.91,,,317.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.38,,,334.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.38,,,190.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.38,,,334.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.35,,,190.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.77,,,366.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.85,,,240.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,317.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,317.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.99,,,374.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.49,,,207.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.99,,,345.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,227.92,,,366.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,229.04,,,386.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,229.04,
HC VITAMIN D 25 HYDROXY,Px00030013010,CDM,82306,CPT,300,RC,,,,BOTH,,,239,215.1,227.05,,,215.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.42,,,186.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.1,,,198.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.1,,,121.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.1,,,198.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.11,,,121.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.1,,,215.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.44,,,229.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.67,,,186.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.28,,,186.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.88,,,219.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.11,,,121.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.15,,,203.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.05,,,215.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.1,,,227.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.11,,,117.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,186.42,229.44,
HC PR ED 28495 TREAT BIG TOE FRACTURE W/MANIPULATION CDM,Px00098110443,CDM,28495,CPT,981,RC,,,,OUTPATIENT,,,601,540.9,336.56,,,540.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.48,,,468.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.63,,,500.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.63,,,306.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.63,,,500.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.18,,,306.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.28,,,540.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.55,,,576.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.94,,,468.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.94,,,468.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.57,,,552.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.59,,,306.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.57,,,510.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336.56,,,540.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,570.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.94,,,154.94,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,154.94,229.5,
HC KIT DRESSING NEGATIVE PRESSURE V.A.C. GRANUFOAM SMALL 7.5CM X 10CM 3.3CM THK,Sx0M8275051/5,CDM,,,270,RC,,,,BOTH,,,239.32,167.6,227.35,,,215.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.67,,,186.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,199.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,121.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,199.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.27,,,121.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,215.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.75,,,229.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.9,,,186.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.44,,,186.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.17,,,220.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.27,,,121.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.42,,,203.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.35,,,215.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,227.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.27,,,117.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,186.67,229.75,
HC PR ED 11750 REMOVAL OF NAIL BED CDM,Px00098110254,CDM,11750,CPT,981,RC,,,,OUTPATIENT,,,384,345.6,215.04,,,345.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.91,,,299.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240,,,329.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240,,,329.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.68,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.97,,,345.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.2,,,234.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.59,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,100.59,,,299.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,353.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.61,,,195.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.88,,,326.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.04,,,345.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,229.95,,,364.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,100.59,,,100.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,100.59,229.95,
HC DIRECT REFER HOSPITAL OBSERV,Px00076210010,CDM,G0379,CPT,762,RC,,,,BOTH,,,240,172.8,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.4,,,230.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.8,,,220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204,,,204,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,228,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,117.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.2,230.4,
HC FLUENT WASTE BAG PACKAGED,Sx0000FLT-005,CDM,,,270,RC,,,,BOTH,,,240,216,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.4,,,230.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.78,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.8,,,220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204,,,204,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,228,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,117.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.2,230.4,
HC SCREW LO-PROFILE TI 3.5 X 18MM,Sx0AR-8935-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,240,216,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.4,,,230.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.78,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.8,,,220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204,,,204,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,228,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,117.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.2,230.4,
HC SCREW LO-PROFILE TI 3.5 X 24MM,Sx0AR-8935-24,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,240,216,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.4,,,230.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.78,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.8,,,220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204,,,204,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216,,,228,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,117.6,,,117.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,187.2,230.4,
HC APPLICATOR FLEX TIP FOR ARISTA,Sx00000AM0010,CDM,,,270,RC,,,,BOTH,,,241.44,217.3,229.37,,,217.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.32,,,188.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.3,,,200.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.3,,,123.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.3,,,200.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.31,,,123.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.3,,,217.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.78,,,231.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.46,,,188.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.49,,,188.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.12,,,222.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.31,,,123.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.22,,,205.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.37,,,217.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.3,,,229.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.31,,,118.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,188.32,231.78,
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION #,Px00030600284,CDM,87522,CPT,300,RC,,,,BOTH,,,241.62,217.46,229.54,,,217.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.46,,,188.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.46,,,201.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.46,,,123.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.46,,,201.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.39,,,123.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.46,,,217.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.96,,,231.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.59,,,188.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.58,,,188.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.29,,,222.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.39,,,123.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.38,,,205.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.54,,,217.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.46,,,229.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.39,,,118.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,188.46,231.96,
HC US EXAM SCROTUM & CONTENTS,Px00040210036,CDM,76870,CPT,402,RC,,,,BOTH,,,242,217.8,229.9,,,217.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.76,,,188.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.8,,,201.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.8,,,123.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.8,,,201.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.58,,,123.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.8,,,217.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.32,,,232.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.87,,,188.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.77,,,188.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.64,,,222.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.58,,,123.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.7,,,205.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.9,,,217.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.8,,,229.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.58,,,118.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,188.76,232.32,
HC PARATHORMONE (PARATHYROID HORMONE),Px00030112161,CDM,83970,CPT,300,RC,,,,BOTH,,,242.12,217.91,230.01,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.85,,,188.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.91,,,201.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.91,,,123.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.91,,,201.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.64,,,123.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.91,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.96,,,188.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,119.83,,,188.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.75,,,222.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.64,,,123.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.01,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.91,,,230.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.64,,,118.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,188.85,232.44,
HC PR 56440 SURGERY FOR VULVA LESION,Px00097511041,CDM,56440,CPT,975,RC,,,,BOTH,,,435,391.5,243.6,,,391.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.53,,,339.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.88,,,358.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.88,,,207.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.88,,,358.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.82,,,207.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.83,,,391.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,250.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,339.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,339.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.95,,,400.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.44,,,221.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.95,,,369.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.6,,,391.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.65,,,413.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.31,,,108.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,108.31,232.65,
HC INSUFFLATION NEEDLE 150MM ENDOPATH PNEUMONEEDLE PN150,Sx000000PN150,CDM,,,270,RC,,,,BOTH,,,242.47,65.45,230.35,,,69.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.13,,,59.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.22,,,63.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.22,,,39.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.22,,,63.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.81,,,39.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.22,,,69.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.77,,,73.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.22,,,59.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120,,,59.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.07,,,70.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.81,,,39.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.1,,,65.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.35,,,69.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.22,,,72.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.81,,,118.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,189.13,232.77,
HC CATH EPISTAXIS BALLOON GYRUS ENT DIV,Sx00000890912,CDM,,,270,RC,,,,BOTH,,,242.5,218.25,230.38,,,218.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.15,,,189.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,201.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,123.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,201.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.83,,,123.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,218.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.8,,,232.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.24,,,189.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.01,,,189.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.1,,,223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.83,,,123.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.13,,,206.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.38,,,218.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,230.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,118.83,,,118.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,189.15,232.8,
HC FLUOROSCOPY UP TO 1 HR,Px00032010318,CDM,76000,CPT,402,RC,,,,BOTH,,,243,218.7,230.85,,,218.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.54,,,189.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.7,,,202.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.7,,,123.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.7,,,202.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,123.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.7,,,218.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.28,,,233.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,178.61,,,189.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.26,,,189.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.56,,,223.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,123.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.55,,,206.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.85,,,218.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.7,,,230.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.07,,,119.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,189.54,233.28,
HC RBC ANTIBODY ELUTION,Px00030011742,CDM,86860,CPT,300,RC,,,,BOTH,,,244,209.7,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.32,,,190.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,124.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.24,,,234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.34,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.76,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.48,,,224.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.4,,,207.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,119.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,190.32,234.24,
HC TRICHOMONAS VAGINALIS AMPLIF,Px00030010093,CDM,87661,CPT,300,RC,,,,BOTH,,,244,219.6,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.32,,,190.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,124.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.24,,,234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.34,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.76,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.48,,,224.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.4,,,207.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,119.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,190.32,234.24,
HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH #,Px00030600400,CDM,87661,CPT,300,RC,,,,BOTH,,,244,219.6,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.32,,,190.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,124.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.24,,,234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.34,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.76,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.48,,,224.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.4,,,207.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,119.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,190.32,234.24,
HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM #,Px00030610200,CDM,87798,CPT,300,RC,,,,BOTH,,,244,219.6,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.32,,,190.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,124.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.24,,,234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.34,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.76,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.48,,,224.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.4,,,207.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,119.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,190.32,234.24,
HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM #,Px00030610201,CDM,87798,CPT,300,RC,,,,BOTH,,,244,219.6,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.32,,,190.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,124.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,203.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.24,,,234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.34,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.76,,,190.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.48,,,224.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,124.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.4,,,207.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.8,,,219.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.6,,,231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,119.56,,,119.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,190.32,234.24,
HC PR ED 27250 CLOSED TX HIP DISLOCATION W/O ANESTH CDM,Px00098110850,CDM,27250,CPT,981,RC,,,,OUTPATIENT,,,427,384.3,239.12,,,384.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,217.13,,,333.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.88,,,355.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.88,,,217.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.88,,,355.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,451.21,,,217.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.08,,,384.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.85,,,409.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,392.36,,,333.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.36,,,333.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.39,,,392.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,404.13,,,217.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.39,,,362.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.12,,,384.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.45,,,405.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,392.36,,,392.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,392.36,234.45,
HC K-WIRE 0.045 IN (1.143MM) W/LNGTH MARKINGS,Sx00007-40281,CDM,,,270,RC,,,,BOTH,,,245,220.5,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.1,,,191.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,124.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.08,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.4,,,225.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.25,,,208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,232.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,120.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.1,235.2,
HC K-WIRE 1.4X150MM SMOOTH TROCAR TIP,Sx0AGK0214150,CDM,,,270,RC,,,,BOTH,,,245,220.5,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.1,,,191.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,124.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.08,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.4,,,225.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.25,,,208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,232.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,120.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.1,235.2,
HC PHENYLALANINE PKU BLOOD,Px00030013137,CDM,84030,CPT,300,RC,,,,BOTH,,,245,220.5,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.1,,,191.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,124.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.08,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.4,,,225.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.25,,,208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,232.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,120.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.1,235.2,
HC METABOLIC SCRN NEWBORN,Px00030011718,CDM,S3620,CPT,300,RC,,,,BOTH,,,245,220.5,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.1,,,191.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,124.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.08,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.4,,,225.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.25,,,208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,232.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,120.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.1,235.2,
HC XR KNEES STANDING BILAT,Px00032010156,CDM,73565,CPT,320,RC,,,,BOTH,,,245,220.5,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.1,,,191.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,124.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,203.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,180.08,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.25,,,191.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.4,,,225.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,124.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.25,,,208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.75,,,220.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,232.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,120.05,,,120.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,191.1,235.2,
HC BURR OVAL 8 FLUTE 4.0MM X 13CM,Sx0AR-8400OBE,CDM,,,270,RC,,,,BOTH,,,247.8,223.02,235.41,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.28,,,193.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,206.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,126.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,206.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,126.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.89,,,237.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,193.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.64,,,193.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,227.98,,,227.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,126.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,210.63,,,210.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.41,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,235.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,121.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,193.28,237.89,
HC EXCALIBUR 4.0MM X 13CM,Sx00AR-8400EX,CDM,,,270,RC,,,,BOTH,,,247.8,223.02,235.41,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.28,,,193.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,206.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,126.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,206.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,126.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.89,,,237.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,193.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.64,,,193.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,227.98,,,227.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,126.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,210.63,,,210.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.41,,,223.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,235.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,121.42,,,121.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,193.28,237.89,
HC PEG STANDARD PULL ENTAKE SYSTEM KIT 20FR,Sx000030-6520,CDM,,,270,RC,,,,BOTH,,,249.1,224.19,236.65,,,224.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.3,,,194.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.19,,,207.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.19,,,126.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.19,,,207.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.06,,,126.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.19,,,224.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.14,,,239.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.09,,,194.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.28,,,194.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.17,,,229.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.06,,,126.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.74,,,211.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.65,,,224.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.19,,,236.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.06,,,122.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,194.3,239.14,
HC PR 32552 REMOVE LUNG CATHETER,Px00097512454,CDM,32552,CPT,975,RC,,,,BOTH,,,434,390.6,243.04,,,390.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,338.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.25,,,361.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.25,,,221.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.25,,,361.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.39,,,221.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.33,,,390.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,238.7,,,416.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,151.64,,,338.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,151.64,,,338.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.38,,,399.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.19,,,221.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.38,,,368.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.04,,,390.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,412.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,151.64,,,151.64,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,151.64,239.4,
HC CATH PER Q 5FR MIDLINE,Px00008438WNH,CDM,,,270,RC,,,,BOTH,,,249.9,224.91,237.41,,,224.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.92,,,194.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.91,,,208.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.91,,,127.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.91,,,208.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.45,,,127.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.91,,,224.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.9,,,239.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.68,,,194.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.68,,,194.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.91,,,229.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.45,,,127.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.42,,,212.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.41,,,224.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.91,,,237.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.45,,,122.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,194.92,239.9,
HYALURONIDASE HUMAN INJ 150 UNIT/ML,Rx18657011701,CDM,J3473,HCPCS,636,RC,18657011701,NDC,,BOTH,1,ML,250,225,237.5,,,237.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,183.75,,,183.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.5,,,237.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC OXYGEN PER DAY,Px00027002WNH,CDM,,,270,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC NO 2 FIBERSTICK NO 2 FIBERWIRE,Sx0000AR-7209,CDM,,,270,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC TIGERSTICK NO 2 TIGERWIRE,Sx000AR-7209T,CDM,,,270,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC FIBERLOOP NO 2 BLUE,Sx0000AR-7234,CDM,,,270,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC BURR OVAL 12 FLUTE 5.5MM X 13C,Sx0AR-8550OBT,CDM,,,270,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC NATRIURETIC PEPTIDE #,Px00030100630,CDM,83880,CPT,300,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC NATRIURETIC PEPTIDE #,Px00030100631,CDM,83880,CPT,300,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HC NATRIURETIC PEPTIDE,Px00030112024,CDM,83880,CPT,300,RC,,,,BOTH,,,250,225,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.73,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
HYALURONIDASE HUMAN INJ 150 UNIT/ML,Rx18657011702,CDM,J3473,HCPCS,636,RC,18657011702,NDC,,BOTH,1,ML,250,225,237.5,,,225.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195,,,195.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,127.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,208.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225,,,225.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240,,,240.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.75,,,195.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,195.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230,,,230.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,127.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.5,,,212.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.5,,,225.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225,,,237.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.5,,,122.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195,240,
POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K),Rx65219005409,CDM,,,250,RC,65219-0054-09,NDC,,BOTH,15,ML,250.18,225.16,237.67,,,225.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.14,,,195.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,208.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,127.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,208.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.59,,,127.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,225.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.17,,,240.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.88,,,195.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.81,,,195.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230.17,,,230.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.59,,,127.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.65,,,212.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.67,,,225.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,237.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.59,,,122.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195.14,240.17,
HC SAM PELVIC II SLING LG,Px00013634WNH,CDM,,,270,RC,,,,BOTH,,,250.2,225.18,237.69,,,225.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.16,,,195.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,208.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,127.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,208.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.6,,,127.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,225.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.19,,,240.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.9,,,195.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,123.82,,,195.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230.18,,,230.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.6,,,127.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.67,,,212.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.69,,,225.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,237.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,122.6,,,122.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,195.16,240.19,
HC PR ED 69000 DRAIN EXTERNAL EAR LESION SIMPLE CDM,Px00098110827,CDM,69000,CPT,981,RC,,,,OUTPATIENT,,,466,419.4,260.96,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.96,,,363.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,237.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.23,,,237.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.89,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.3,,,447.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.55,,,363.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.55,,,363.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.62,,,428.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,128.29,,,237.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.62,,,396.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.96,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.75,,,442.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.55,,,124.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,124.55,240.75,
HC KIT DRESSING NEGATIVE PRESSURE V.A.C. GRANUFOAM SIMPLACE NON-ADHERENT SMALL 7.5CM X 11.5CM 1.7SPIRAL,Sx0M8275041/5,CDM,,,270,RC,,,,BOTH,,,251.29,179.39,238.73,,,226.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.01,,,196.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.16,,,209.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.16,,,128.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.16,,,209.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,128.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.16,,,226.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.24,,,241.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,184.7,,,196.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.36,,,196.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.19,,,231.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,128.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.6,,,213.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.73,,,226.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.16,,,238.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,123.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.01,241.24,
HC LATERAL TRACTION SLING S3,Sx0000AR-1652,CDM,,,270,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X44MM IMPLNT,Sx00040-35044,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X55MM IMPLNT,Sx00040-35055,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X60MM IMPLNT,Sx00040-35060,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X36MM IMPLNT,Sx00040-35036,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X14MM IMPL,Sx00040-35014,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW BONE T10 3.5X24MM IMPL,Sx00040-35024,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC SCREW LO-PROFILE TI 3.5 X 14MM,Sx0AR-8935-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,252,226.8,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.56,,,196.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,128.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,209.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.92,,,241.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.71,,,196.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.84,,,231.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,128.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,214.2,,,214.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,226.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.8,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,123.48,,,123.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,196.56,241.92,
HC BLADE AGGRESSIVE PLUS 4MM STRT,Sx375-544-000,CDM,,,270,RC,,,,BOTH,,,253.36,106.65,240.69,,,228.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.62,,,197.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.02,,,210.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.02,,,129.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.02,,,210.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.15,,,129.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.02,,,228.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.23,,,243.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.22,,,197.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,125.39,,,197.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,233.09,,,233.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.15,,,129.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.36,,,215.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.69,,,228.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.02,,,240.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.15,,,124.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,197.62,243.23,
HC PR ED 12006 REPAIR SUPERFIC WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TR CDM,Px00098110263,CDM,12006,CPT,981,RC,,,,OUTPATIENT,,,495,445.5,277.2,,,445.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.87,,,386.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,309.38,,,412.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,309.38,,,252.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,309.38,,,412.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,127.67,,,252.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.59,,,445.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.25,,,475.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.02,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,111.02,,,386.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,282.15,,,455.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.35,,,252.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,282.15,,,420.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,445.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.9,,,470.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.02,,,111.02,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,111.02,243.9,
HC RECOVERY CLASS II - ADDL 15 MIN,Px00071010114,CDM,,,710,RC,,,,BOTH,,,255,229.5,242.25,,,229.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.9,,,198.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,212.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,129.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,212.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,129.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,229.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.8,,,244.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.43,,,198.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,198.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.6,,,234.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,129.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216.75,,,216.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.25,,,229.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,242.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,124.95,,,124.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,198.9,244.8,
HC TCC-EZ CASTING BOOT REGULAR,Sx000TCC21100,CDM,,,270,RC,,,,BOTH,,,255.72,230.15,242.93,,,230.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.46,,,199.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.15,,,212.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.15,,,130.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.15,,,212.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.3,,,130.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230.15,,,230.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,245.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.95,,,199.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.56,,,199.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.26,,,235.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.3,,,130.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.36,,,217.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.93,,,230.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.15,,,242.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.3,,,125.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,199.46,245.49,
HC PR 49082 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE  CDM,Px00097514077,CDM,49082,CPT,975,RC,,,,BOTH,,,530,477,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.22,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.59,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.5,,,100.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,487.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.75,,,270.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,450.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.7,,,503.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,70.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.63,245.7,
HC PR 49082 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM,Px00098300096,CDM,49082,CPT,983,RC,,,,BOTH,,,530,477,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.22,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.59,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.5,,,100.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,487.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.75,,,270.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,450.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.7,,,503.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,70.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.63,245.7,
HC PR ED 49082 ABD PARACENT W/O IMAG GUID CDM,Px00098110907,CDM,49082,CPT,981,RC,,,,OUTPATIENT,,,530,477,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,99.28,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.25,,,394.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.22,,,82.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,88.59,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.5,,,100.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,413.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,487.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.75,,,270.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.1,,,450.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.8,,,477,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.7,,,503.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.63,,,70.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.63,245.7,
HC ARTHROSCOPY PUMP TUBING AR-6410,Sx0000AR-6410,CDM,,,270,RC,,,,BOTH,,,256.2,230.58,243.39,,,230.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.84,,,199.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.58,,,213.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.58,,,130.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.58,,,213.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.54,,,130.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230.58,,,230.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.95,,,245.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.31,,,199.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.79,,,199.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.7,,,235.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.54,,,130.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.77,,,217.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.39,,,230.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.58,,,243.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.54,,,125.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,199.84,245.95,
HC US EXAM CHEST,Px00040210005,CDM,76604,CPT,402,RC,,,,BOTH,,,257,231.3,244.15,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.46,,,200.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.3,,,213.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.3,,,130.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.3,,,213.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.93,,,130.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.3,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.72,,,246.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.9,,,200.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,127.19,,,200.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,236.44,,,236.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.93,,,130.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.45,,,218.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.15,,,231.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.3,,,244.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,125.93,,,125.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,200.46,246.72,
HC PR ED 11760 REPAIR OF NAIL BED CDM,Px00098110256,CDM,11760,CPT,981,RC,,,,OUTPATIENT,,,468,421.2,262.08,,,421.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,167.94,,,365.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.5,,,389.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.5,,,238.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.5,,,389.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.07,,,238.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.39,,,421.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.4,,,449.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.89,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,107.89,,,365.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,430.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.13,,,238.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,397.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,262.08,,,421.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.49,,,444.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.89,,,107.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,107.89,247.49,
HC PR ED 42700 DRAINAGE OF TONSIL ABSCESS CDM,Px00098110366,CDM,42700,CPT,981,RC,,,,OUTPATIENT,,,326,293.4,182.56,,,293.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.12,,,254.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.75,,,271.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.75,,,166.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.75,,,271.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.12,,,166.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.18,,,293.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,179.3,,,312.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.76,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.76,,,254.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.82,,,299.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.83,,,166.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.82,,,277.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.56,,,293.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.95,,,309.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.76,,,135.76,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,135.76,247.95,
HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM,Px00076110490,CDM,36592,CPT,761,RC,,,,BOTH,,,262,235.8,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,204.36,,,204.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,133.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.52,,,251.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.57,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.04,,,241.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.7,,,222.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,248.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,128.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,204.36,251.52,
HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM,Px00026010006,CDM,36592,CPT,761,RC,,,,BOTH,,,262,235.8,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,204.36,,,204.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,133.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.52,,,251.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.57,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.04,,,241.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.7,,,222.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,248.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,128.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,204.36,251.52,
HC THERAPUTIC PHLEBOTOMY,Px00094010204,CDM,99195,CPT,940,RC,,,,BOTH,,,262,235.8,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,204.36,,,204.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,133.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,218.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.96,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.52,,,251.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.57,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,128.38,,,204.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.04,,,241.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.62,,,133.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.7,,,222.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.9,,,235.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.8,,,248.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,134.96,,,128.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,204.36,251.52,
HC NEBULIZER CONTINUOUS 1ST HOUR,Px00041010371,CDM,94644,CPT,410,RC,,,,BOTH,,,264,237.6,250.8,,,250.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,194.04,,,194.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,130.65,,,130.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,250.8,,,250.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC BLOOD DRAW FROM IMPLANTED PORT CDM,Px00076110488,CDM,36591,CPT,761,RC,,,,BOTH,,,264,237.6,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,134.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,250.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC BLOOD DRAW FROM IMPLANTED PORT CDM,Px00026010005,CDM,36591,CPT,761,RC,,,,BOTH,,,264,237.6,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,134.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,250.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC INSERT STRAIGHT CATH BLADDER,Px00094010050,CDM,51701,CPT,761,RC,,,,BOTH,,,264,237.6,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,134.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,250.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,Px00094010051,CDM,51702,CPT,761,RC,,,,BOTH,,,264,237.6,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,244.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,244.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,250.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC NEBULIZER CONTINUOUS FIRST HOUR,Px00041210008,CDM,94644,CPT,410,RC,,,,BOTH,,,264,237.6,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.92,,,205.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,134.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,219.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.44,,,253.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.65,,,205.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.88,,,242.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,134.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.4,,,224.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.8,,,237.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.6,,,250.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.36,,,129.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,205.92,253.44,
HC ASSAY OF PARATHORMONE #,Px00030110189,CDM,83970,CPT,300,RC,,,,BOTH,,,264.56,238.1,251.33,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.36,,,188.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.1,,,201.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.1,,,123.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.1,,,201.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.63,,,123.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238.1,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.98,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.45,,,188.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130.93,,,188.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.4,,,222.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.63,,,123.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,224.88,,,205.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.33,,,217.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.1,,,230.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,129.63,,,129.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,206.36,253.98,
TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),Rx00000000901,CDM,,,250,RC,00000-0009-01,NDC,,BOTH,10,ML,265.41,119.43,252.14,,,238.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.02,,,207.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.87,,,220.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.87,,,135.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.87,,,220.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,135.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238.87,,,238.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.79,,,254.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.08,,,207.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.35,,,207.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.18,,,244.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,135.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.6,,,225.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.14,,,238.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.87,,,252.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.05,,,130.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.02,254.79,
HC SARS COV-2 IMMUNE RESPONSE IGG,Px00030210241,CDM,86769,CPT,300,RC,,,,BOTH,,,265.5,238.95,252.23,,,238.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.09,,,207.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.95,,,221.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.95,,,135.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.95,,,221.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.1,,,135.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238.95,,,238.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.88,,,254.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.14,,,207.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.4,,,207.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.26,,,244.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.1,,,135.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.68,,,225.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.23,,,238.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.95,,,252.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.1,,,130.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.09,254.88,
HC TOMCAT CURVED 4MM SHAVER,Sx380-545-100,CDM,,,270,RC,,,,BOTH,,,265.83,230.04,252.54,,,239.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.35,,,207.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,221.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,135.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,221.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.26,,,135.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,239.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.2,,,255.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.39,,,207.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.56,,,207.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.56,,,244.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.26,,,135.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.96,,,225.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.54,,,239.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.25,,,252.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.26,,,130.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.35,255.2,
HC RBC ANTIBODY IDENTIFICATION,Px00030011046,CDM,86870,CPT,300,RC,,,,BOTH,,,266,232.2,252.7,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.48,,,207.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,221.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,135.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,221.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.34,,,135.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.36,,,255.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,207.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.64,,,207.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.72,,,244.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.34,,,135.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.1,,,226.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.7,,,239.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.4,,,252.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.34,,,130.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.48,255.36,
HC SCREW BONE 2.3X8MM SELF-TAP CROSSPIN,Sx0058-23008E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC SCREW BONE 2.3X10MM SELF-TAP CROSSPIN,Sx0058-23010E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC SCREW BONE 2.3X12MM SELF-TAP CROSSPIN,Sx0058-23012E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC SCREW BONE 2.3X20MM SELF-TAP CROSSPIN,Sx0058-23020E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC SCREW BONE 2.3X22MM SELF-TAP CROSSPIN,Sx0058-23022E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC SCREW BONE 2.3X24MM SELF-TAP CROSSPIN,Sx0058-23024E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,266.4,239.76,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.79,,,207.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,135.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,221.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.74,,,255.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.8,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.84,,,207.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.09,,,245.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,135.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.44,,,226.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.08,,,239.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.76,,,253.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.54,,,130.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.79,255.74,
HC VISTA RIGID CERVICAL COLLAR,Px00013591WNH,CDM,,,270,RC,,,,BOTH,,,266.44,239.8,253.12,,,239.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,207.82,,,207.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.8,,,221.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.8,,,135.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.8,,,221.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.56,,,135.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.8,,,239.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,255.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.83,,,207.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.86,,,207.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.12,,,245.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.56,,,135.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.47,,,226.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.12,,,239.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.8,,,253.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,130.56,,,130.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,207.82,255.78,
HC PR 32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING [32554] CDM,Px00098300181,CDM,32554,CPT,975,RC,,,,BOTH,,,207,186.3,115.92,,,186.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.96,,,161.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.38,,,172.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.38,,,105.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.38,,,172.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.89,,,105.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.05,,,186.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,113.85,,,198.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,161.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,161.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.99,,,190.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.78,,,105.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.99,,,175.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,115.92,,,186.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.49,,,196.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,84.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.25,256.49,
HC PR ED 32554 THORACENTESIS/ASPIR W/O IMG GD CDM,Px00098110931,CDM,32554,CPT,981,RC,,,,OUTPATIENT,,,209,188.1,117.04,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.96,,,163.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,173.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,106.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.63,,,173.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.89,,,106.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.05,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.95,,,200.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,163.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,163.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.13,,,192.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.78,,,106.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.13,,,177.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.04,,,188.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.49,,,198.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,84.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.25,256.49,
HC PR 32554 THORANCENTESIS NEEDLE/CATH PLEURA W/O IMAGING,Px00097511404,CDM,32554,CPT,982,RC,,,,BOTH,,,580,522,324.8,,,522,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.96,,,452.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.5,,,482.79,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.5,,,295.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.5,,,482.79,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.89,,,295.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.05,,,522,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319,,,556.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,452.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,452.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.6,,,533.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.78,,,295.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.6,,,493,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.8,,,522,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.49,,,551,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.25,,,84.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.25,256.49,
"HC HOVERMATT SPU HALF-MATT 34""",SxHM34SPU-HLF,CDM,,,270,RC,,,,BOTH,,,267.44,226.44,254.07,,,240.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.6,,,208.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.7,,,222.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.7,,,136.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.7,,,222.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.05,,,136.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,240.7,,,240.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.74,,,256.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.57,,,208.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.36,,,208.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,246.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.05,,,136.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,227.32,,,227.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.07,,,240.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.7,,,254.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.05,,,131.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,208.6,256.74,
THROMBIN FOR SOLN 5000 UNIT,Rx60793021505,CDM,,,250,RC,60793-0215-05,NDC,,BOTH,1,EA,267.77,241.17,254.38,,,241.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.86,,,208.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.99,,,222.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.99,,,136.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.99,,,222.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.21,,,136.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,240.99,,,241.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.06,,,257.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.81,,,208.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,132.52,,,208.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.35,,,246.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.21,,,136.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,227.6,,,227.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.38,,,241.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.99,,,254.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.21,,,131.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,208.86,257.06,
HC EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT CDM,Px00073100004,CDM,93243,CPT,731,RC,,,,BOTH,,,269,242.1,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.82,,,209.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.24,,,258.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.72,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.48,,,247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.65,,,228.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,255.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,131.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,209.82,258.24,
HC EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT CDM,Px00073100002,CDM,93247,CPT,731,RC,,,,BOTH,,,269,242.1,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.82,,,209.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.24,,,258.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.72,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.48,,,247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.65,,,228.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,255.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,131.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,209.82,258.24,
HC BLOOD DRAW ARTERIAL PUNCTURE,Px00041010006,CDM,36600,CPT,761,RC,,,,BOTH,,,269,242.1,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.82,,,209.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.24,,,258.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.72,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.48,,,247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.65,,,228.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,255.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,131.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,209.82,258.24,
HC ASSAY OF ACTH,Px00030013018,CDM,82024,CPT,300,RC,,,,BOTH,,,269,242.1,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.82,,,209.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.24,,,258.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.72,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.13,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.48,,,247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.65,,,228.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,255.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,131.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,209.82,258.24,
HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS,Px00041010338,CDM,94668,CPT,410,RC,,,,BOTH,,,269,242.1,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.82,,,209.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,137.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,223.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.24,,,258.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.72,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.13,,,209.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.48,,,247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,137.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.65,,,228.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.55,,,242.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.1,,,255.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,131.81,,,131.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,209.82,258.24,
HC MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,Px00041010261,CDM,94667,CPT,410,RC,,,,BOTH,,,270,243,256.5,,,243,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.6,,,210.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243,,,224.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243,,,137.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243,,,224.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,137.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243,,,243,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,259.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,210.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.62,,,210.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,248.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,137.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.5,,,229.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.5,,,243,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243,,,256.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.3,,,132.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,210.6,259.2,
HC STAPLER LINEAR PROX 60MM DISP RELOADABLE TX60B,Sx000000TX60B,CDM,,,270,RC,,,,BOTH,,,270.16,249.41,256.65,,,249.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.72,,,216.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.14,,,230.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.14,,,141.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.14,,,230.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.38,,,141.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.14,,,249.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.35,,,266.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.57,,,216.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.7,,,216.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.55,,,254.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.38,,,141.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.64,,,235.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.65,,,249.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.14,,,263.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,132.38,,,132.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,210.72,259.35,
HC GUIDE WIRE 1.4 X 150MM IMPL ASNIS III,Sx00000702459,CDM,C1769,HCPCS,278,RC,,,,BOTH,,,271.74,244.57,258.15,,,244.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.96,,,211.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.57,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.57,,,138.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.57,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,138.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.57,,,244.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.87,,,260.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.73,,,211.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,134.48,,,211.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,250,,,250,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,138.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,230.98,,,230.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.15,,,244.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.57,,,258.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,133.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,211.96,260.87,
HC PR ED 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM,Px00098110398,CDM,54220,CPT,981,RC,,,,OUTPATIENT,,,913,821.7,511.28,,,821.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.6,,,712.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,570.63,,,759.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,570.63,,,465.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,570.63,,,759.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.5,,,465.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,821.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,502.15,,,876.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130,,,712.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,130,,,712.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,520.41,,,839.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,133.9,,,465.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,520.41,,,776.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.28,,,821.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,261.45,,,867.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130,,,130,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,130,261.45,
HC PR ED 12016 REPAIR SUPERFIC WOUND(S) 12.6 TO 20.0CM FACE ERS EYLD N CDM,Px00098110269,CDM,12016,CPT,981,RC,,,,OUTPATIENT,,,925,832.5,518,,,832.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.91,,,721.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.13,,,769.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.13,,,471.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.13,,,769.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.25,,,471.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,832.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.75,,,888,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.09,,,721.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,121.09,,,721.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,527.25,,,851,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.72,,,471.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,527.25,,,786.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,518,,,832.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,261.9,,,878.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.09,,,121.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,121.09,261.9,
HC CUTTER LINEAR 55MM TITANIUM STAPLES TLC55,Sx000000TLC55,CDM,,,270,RC,,,,BOTH,,,273.38,250,259.71,,,250,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.24,,,216.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,231.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,141.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,231.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.96,,,141.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,250,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.44,,,266.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.93,,,216.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,135.3,,,216.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,251.51,,,255.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.96,,,141.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,232.37,,,236.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.71,,,250,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.04,,,263.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,133.96,,,133.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,213.24,262.44,
HC PR 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE  CDM,Px00097513993,CDM,10061,CPT,975,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.68,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.45,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.51,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,240.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,187.59,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.26,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,182.13,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,182.13,263.26,
HC PR ED 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM,Px00098110231,CDM,10061,CPT,981,RC,,,,OUTPATIENT,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.68,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,361.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.45,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.51,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,240.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,187.59,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.26,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.13,,,182.13,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,182.13,263.26,
MEDROXYPROGESTERONE ACETATE IM SUSP PREFILLED SYR 150 MG/ML,Rx59762453802,CDM,J1050,HCPCS,636,RC,59762453802,NDC,,BOTH,1,ML,274.59,247.13,260.86,,,260.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.18,,,214.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,247.13,,,247.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,247.13,,,247.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,247.13,,,247.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,134.55,,,134.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,247.13,,,247.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.61,,,263.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,201.82,,,201.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,134.55,,,134.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.62,,,252.62,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,134.55,,,134.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,233.4,,,233.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,260.86,,,260.86,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,247.13,,,247.13,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,134.55,,,134.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,214.18,263.61,
HC PR 59160 D & C AFTER DELIVERY,Px00097510605,CDM,59160,CPT,975,RC,,,,BOTH,,,664,597.6,371.84,,,597.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,207.2,,,517.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415,,,552.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415,,,338.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415,,,552.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.64,,,338.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.12,,,597.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,365.2,,,637.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.43,,,517.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.43,,,517.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.48,,,610.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.87,,,338.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.48,,,564.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,371.84,,,597.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.7,,,630.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.43,,,181.43,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,181.43,263.7,
HC PR 46220 EXCISE ANAL EXTERNAL TAG/PAPILLA,Px00097510786,CDM,46220,CPT,975,RC,,,,BOTH,,,600,540,336,,,540,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.16,,,468,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375,,,481.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375,,,481.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.61,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.59,,,540,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330,,,161.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.53,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,120.53,,,468,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342,,,552,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.15,,,305.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342,,,510,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336,,,540,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,570,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.53,,,120.53,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,120.53,264.6,
HC ALEXIS O WOUND PROTECTOR LARGE RETRACTOR 9 - 14CM,Sx000000C8303,CDM,,,270,RC,,,,BOTH,,,276,203.4,262.2,,,248.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.28,,,215.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,229.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,140.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,229.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.24,,,140.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,248.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.96,,,264.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,215.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.59,,,215.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.92,,,253.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.24,,,140.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.6,,,234.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.2,,,248.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.4,,,262.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.24,,,135.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,215.28,264.96,
HC EXCALIBUR CURVED 4.0MM,Sx0AR-8400CEX,CDM,,,270,RC,,,,BOTH,,,277.2,249.48,263.34,,,249.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.22,,,216.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.48,,,230.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.48,,,141.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.48,,,230.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.83,,,141.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,249.48,,,249.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.11,,,266.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.74,,,216.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.19,,,216.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.02,,,255.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.83,,,141.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.62,,,235.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.34,,,249.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.48,,,263.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,135.83,,,135.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,216.22,266.11,
HC THORACENTESIS TRAY WITH PLURA-SEAL VALVE **CONTAINS LATEX**,Sx000AK-01000,CDM,,,270,RC,,,,BOTH,,,278,250.2,264.1,,,250.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.84,,,216.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.2,,,231.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.2,,,141.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.2,,,231.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.22,,,141.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,250.2,,,250.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.88,,,266.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,204.33,,,216.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.58,,,216.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.76,,,255.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.22,,,141.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,236.3,,,236.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.1,,,250.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.2,,,264.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,136.22,,,136.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,216.84,266.88,
THROMBIN FOR SOLN 5000 UNIT,Rx60793031501,CDM,,,250,RC,60793-0315-01,NDC,,BOTH,1,EA,279.78,251.8,265.79,,,265.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,218.23,,,218.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,251.8,,,251.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,251.8,,,251.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,251.8,,,251.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,137.09,,,137.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,251.8,,,251.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,268.59,,,268.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,205.64,,,205.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,138.46,,,138.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,257.4,,,257.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,137.09,,,137.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,237.81,,,237.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,265.79,,,265.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,251.8,,,251.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,137.09,,,137.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,218.23,268.59,
HC RECOVERY CLASS III - ADDL 15 MIN,Px00071010118,CDM,,,710,RC,,,,BOTH,,,280,252,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.4,,,218.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,142.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.8,,,268.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.6,,,257.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238,,,238,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,266,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,137.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,218.4,268.8,
HC SMARTVEST LARGE PERCUSSION WRAP VEST,Sx00001900435,CDM,,,270,RC,,,,BOTH,,,280,252,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.4,,,218.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,142.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.8,,,268.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138.57,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.6,,,257.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238,,,238,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,266,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,137.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,218.4,268.8,
HC LABRALTAPE WHITE 1.5MM 36 IN,Sx0000AR-7276,CDM,,,270,RC,,,,BOTH,,,280,252,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,218.4,,,218.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,142.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,233.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.8,,,268.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,138.57,,,218.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.6,,,257.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,142.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,238,,,238,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266,,,252,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252,,,266,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,137.2,,,137.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,218.4,268.8,
HC ALDOSTERONE BLD,Px00030014129,CDM,82088,CPT,300,RC,,,,BOTH,,,284,255.6,269.8,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,221.52,,,221.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,236.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,144.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,236.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,144.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,272.64,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.74,,,221.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.55,,,221.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.28,,,261.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,144.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.4,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.8,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,269.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,139.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,221.52,272.64,
HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE #,Px00030010015,CDM,87634,CPT,300,RC,,,,BOTH,,,284,255.6,269.8,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,221.52,,,221.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,236.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,144.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,236.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,144.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,272.64,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,208.74,,,221.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,140.55,,,221.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.28,,,261.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,144.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.4,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.8,,,255.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.6,,,269.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.16,,,139.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,221.52,272.64,
HC DRILL BIT CALIBRATED 2.5MM,Sx0AR-8916-06,CDM,,,270,RC,,,,BOTH,,,285.6,257.04,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.77,,,222.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,145.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.18,,,274.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.92,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.34,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,262.75,,,262.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.76,,,242.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,139.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,222.77,274.18,
HC SCREW BONE T7 2.7X16MM IMPLNT,Sx00040-27016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,285.6,257.04,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.77,,,222.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,145.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.18,,,274.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.92,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.34,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,262.75,,,262.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.76,,,242.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,139.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,222.77,274.18,
HC SCREW BONE T7 2.7X22MM IMPLNT,Sx00040-27022,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,285.6,257.04,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.77,,,222.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,145.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.18,,,274.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.92,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.34,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,262.75,,,262.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.76,,,242.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,139.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,222.77,274.18,
HC SCREW BONE T7 2.7X26MM IMPLNT,Sx00040-27026,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,285.6,257.04,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.77,,,222.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,145.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,237.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.18,,,274.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.92,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.34,,,222.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,262.75,,,262.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,145.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.76,,,242.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.32,,,257.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.04,,,271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,139.94,,,139.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,222.77,274.18,
HC STAPLER LINEAR PROX 30MM RELOADABLE TL30,Sx0000000TL30,CDM,,,270,RC,,,,BOTH,,,286.72,258.05,272.38,,,258.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.64,,,223.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.05,,,238.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.05,,,146.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.05,,,238.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.49,,,146.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.05,,,258.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.25,,,275.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.74,,,223.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.9,,,223.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.78,,,263.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.49,,,146.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.71,,,243.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,272.38,,,258.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.05,,,272.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,140.49,,,140.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,223.64,275.25,
HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS,Px00032010067,CDM,72114,CPT,320,RC,,,,BOTH,,,288,259.2,273.6,,,259.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.64,,,224.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,239.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,146.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,239.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.12,,,146.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,259.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.48,,,276.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,224.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.53,,,224.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.96,,,264.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.12,,,146.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.8,,,244.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,259.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.2,,,273.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.12,,,141.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,224.64,276.48,
HC PR 55100 DRAINAGE SCROTAL WALL ABSCESS CDM,Px00097513958,CDM,55100,CPT,975,RC,,,,BOTH,,,400,360,224,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.66,,,312,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,332.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,332.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.51,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.58,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220,,,384,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,312,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228,,,368,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.53,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228,,,340,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.19,,,380,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,166.53,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,166.53,277.19,
HC PR ED 55100 DRAINAGE OF SCROTUM ABSCESS CDM,Px00098110399,CDM,55100,CPT,981,RC,,,,OUTPATIENT,,,400,360,224,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.66,,,312,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,332.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250,,,332.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.51,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.58,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220,,,384,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,312,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228,,,368,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.53,,,203.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228,,,340,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224,,,360,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.19,,,380,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.53,,,166.53,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,166.53,277.19,
HC CORONAVIRUS AG IA #,Px00030600007,CDM,87426,CPT,300,RC,,,,BOTH,,,289,260.1,274.55,,,260.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,225.42,,,225.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.1,,,240.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.1,,,147.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.1,,,240.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.61,,,147.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,260.1,,,260.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.44,,,277.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,212.42,,,225.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.03,,,225.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.88,,,265.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.61,,,147.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.65,,,245.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.55,,,260.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.1,,,274.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,141.61,,,141.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,225.42,277.44,
HC PR 11404 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM  CDM,Px00097514002,CDM,11404,CPT,975,RC,,,,BOTH,,,540,486,302.4,,,486,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.8,,,421.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.5,,,439.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.5,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.5,,,439.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.83,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.11,,,486,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,297,,,217.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,164.2,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.2,,,421.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,496.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.13,,,275.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,459,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,486,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.65,,,513,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,164.2,,,164.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,164.2,277.65,
HC THE ECOSUCTIONER MAT DISPOSABLE SURGICAL MAT,Sx0000USA-XG8,CDM,,,270,RC,,,,BOTH,,,289.8,260.82,275.31,,,260.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.04,,,226.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,241.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,147.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,241.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142,,,147.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,260.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.21,,,278.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213,,,226.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.42,,,226.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.62,,,266.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142,,,147.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.33,,,246.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.31,,,260.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,275.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142,,,142,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.04,278.21,
HC L&D TRIAGE ESTAB PATIENT LVL 1 CDM,Px00076110507,CDM,99211,CPT,761,RC,,,,BOTH,,,290,180,275.5,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.2,,,187.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,122.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,199.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.4,,,230.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,187.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.8,,,220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,122.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.5,,,204,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.5,,,216,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,228,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,142.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.2,278.4,
HC ALEXIS O WOUND PROTECTOR XL RETRACTOR 11 - 17CM X-LARGE,Sx000000C8304,CDM,,,270,RC,,,,BOTH,,,290,261,275.5,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.2,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.4,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.52,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.8,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.5,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.5,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,142.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.2,278.4,
HC XR ENTIRE SPINE 2 OR 3 VIEWS,Px00032010605,CDM,72082,CPT,320,RC,,,,BOTH,,,290,261,275.5,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.2,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.4,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.52,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.8,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,246.5,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.5,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,142.1,,,142.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.2,278.4,
ZOLEDRONIC ACID IV SOLN 5 MG/100ML,Rx63323096600,CDM,J3489,HCPCS,636,RC,63323096600,NDC,,BOTH,100,ML,290.25,261.83,275.74,,,275.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,226.4,,,226.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,261.23,,,261.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,261.23,,,261.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,261.23,,,261.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,142.22,,,142.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,261.23,,,261.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,278.64,,,278.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,213.33,,,213.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,142.22,,,142.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,267.03,,,267.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,142.22,,,142.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,246.71,,,246.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,275.74,,,275.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,261.23,,,261.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,142.22,,,142.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.4,278.64,
ZOLEDRONIC ACID IV SOLN 5 MG/100ML,Rx55111068852,CDM,J3489,HCPCS,636,RC,55111068852,NDC,,BOTH,100,ML,292.27,263.04,277.66,,,277.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,227.97,,,227.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.04,,,263.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.04,,,263.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.04,,,263.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,143.21,,,143.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,263.04,,,263.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,280.58,,,280.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.82,,,214.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,143.21,,,143.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,268.89,,,268.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,143.21,,,143.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,248.43,,,248.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,277.66,,,277.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.04,,,263.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,143.21,,,143.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,227.97,280.58,
HC BUR ROUND 6 FLUTE F-SER 5.5MM,Sx375-950-000,CDM,,,270,RC,,,,BOTH,,,292.68,104.22,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.29,,,228.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,149.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,263.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.97,,,280.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.12,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.85,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,269.27,,,269.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.78,,,248.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,278.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,143.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,228.29,280.97,
HC BUR BARREL 6 FLUTE F-SER 5.5MM,Sx375-951-000,CDM,,,270,RC,,,,BOTH,,,292.68,104.22,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.29,,,228.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,149.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,263.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.97,,,280.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.12,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.85,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,269.27,,,269.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.78,,,248.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,278.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,143.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,228.29,280.97,
HC BUR ROUND 4.0MM AGGRESSIVE LTX FREE,Sx375-940-000,CDM,,,270,RC,,,,BOTH,,,292.68,104.22,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.29,,,228.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,149.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,243.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,263.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.97,,,280.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.12,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,144.85,,,228.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,269.27,,,269.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,149.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.78,,,248.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.05,,,263.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.41,,,278.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,143.41,,,143.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,228.29,280.97,
HC PR ED 30903 CONTROL OF NOSEBLEED COMPLEX CDM,Px00098110319,CDM,30903,CPT,981,RC,,,,OUTPATIENT,,,325,292.5,182,,,292.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.04,,,253.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.13,,,270.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.13,,,165.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.13,,,270.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.48,,,165.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.77,,,292.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.75,,,312,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.33,,,253.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.33,,,253.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,299,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.56,,,165.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.25,,,276.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182,,,292.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.96,,,308.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.33,,,74.33,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.33,283.96,
HC STAPLER LINEAR 60MM TITANIUM HEAVY WIRE,Sx000000TLH60,CDM,,,270,RC,,,,BOTH,,,296.51,266.86,281.68,,,266.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.28,,,231.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.86,,,246.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.86,,,151.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.86,,,246.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.29,,,151.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.86,,,266.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.65,,,284.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.93,,,231.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,146.74,,,231.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.79,,,272.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.29,,,151.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.03,,,252.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,281.68,,,266.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.86,,,281.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,145.29,,,145.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,231.28,284.65,
HC PR 11443 EXC FACE-MM B9+MARG 2.1-3 CM,Px00097510080,CDM,11443,CPT,975,RC,,,,BOTH,,,545,490.5,305.2,,,490.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,229.96,,,425.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.63,,,453.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.63,,,277.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.63,,,453.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.06,,,277.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.58,,,490.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.75,,,523.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.31,,,425.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.31,,,425.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,501.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.66,,,277.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,463.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,305.2,,,490.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,285.75,,,517.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.31,,,178.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,178.31,285.75,
HC CMV QUANTITATION,Px00030011582,CDM,87497,CPT,300,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION #,Px00030600388,CDM,87522,CPT,300,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC HEPATITIS C QUANTITATIVE PCR PAML,Px00030011653,CDM,87522,CPT,300,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC BK VIRUS QUANT PCR,Px00030011426,CDM,87799,CPT,300,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC BK VIRUS QUANT PCR URINE,Px00030011428,CDM,87799,CPT,300,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC US OB>= 14 WKS ADDL FETUS,Px00040210017,CDM,76810,CPT,402,RC,,,,BOTH,,,298,268.2,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.44,,,232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,151.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,248.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,286.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.48,,,232.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.16,,,274.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,151.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.3,,,253.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.1,,,268.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.2,,,283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.02,,,146.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,232.44,286.08,
HC KIT MICROINTRODUCER 5FR 10 CM,Px00011056WNH,CDM,,,270,RC,,,,BOTH,,,298.72,268.85,283.78,,,268.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233,,,233,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.85,,,248.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.85,,,152.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.85,,,248.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.37,,,152.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.85,,,268.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.77,,,286.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.56,,,233,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.84,,,233,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.82,,,274.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.37,,,152.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.91,,,253.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.78,,,268.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.85,,,283.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,146.37,,,146.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,233,286.77,
HC SUTURE PASSING WIRE,Sx0AR-1255-18,CDM,,,270,RC,,,,BOTH,,,300,270,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234,,,234,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.47,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276,,,276,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255,,,255,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,285,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,147,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,234,288,
HC MESH 6X6 MONOFILAMENT KNITTED POLYPROPYLENE,Sx00000112720,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,300,270,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234,,,234,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.47,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276,,,276,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255,,,255,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,285,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,147,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,234,288,
HC SCREW BONE T7 2.7X18MM IMPL,Sx00040-27018,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,300,270,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234,,,234,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,152.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,249.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,148.47,,,234,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276,,,276,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,152.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255,,,255,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285,,,270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270,,,285,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147,,,147,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,234,288,
HC FOAM VAC MED BLACK GRANUFOAM FREEDOM,Sx0M8275052/5,CDM,,,270,RC,,,,BOTH,,,301.51,206.92,286.43,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.18,,,235.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.36,,,250.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.36,,,153.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.36,,,250.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.74,,,153.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,271.36,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.45,,,289.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,221.61,,,235.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.22,,,235.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.39,,,277.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.74,,,153.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,256.28,,,256.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.43,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.36,,,286.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,147.74,,,147.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,235.18,289.45,
HC PR 99460 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,Px00097511367,CDM,99460,CPT,975,RC,,,,BOTH,,,219,197.1,122.64,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.71,,,170.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,182.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.88,,,182.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.5,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.36,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,120.45,,,210.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,170.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,170.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,201.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.8,,,111.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.83,,,186.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.64,,,197.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,208.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.98,,,28.98,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.98,290.25,
HC PR 97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/<,Px00097510016,CDM,97597,CPT,975,RC,,,,BOTH,,,84,75.6,47.04,,,75.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,44.87,,,65.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.5,,,69.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.5,,,39.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,52.5,,,69.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,39.24,,,39.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,21.22,,,75.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,46.2,,,80.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.12,,,65.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,34.12,,,65.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.88,,,77.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,35.14,,,39.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.88,,,71.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.04,,,75.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,79.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,34.12,,,34.12,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,34.12,290.25,
HC PR 76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I,Px00096300001,CDM,76942,CPT,963,RC,,,,BOTH,,,137,123.3,76.72,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.31,,,106.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,104.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,85.63,,,104.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,64.39,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,38.18,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.48,,,131.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,73.98,,,106.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,64.39,,,106.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.48,,,126.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.08,,,33.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.09,,,116.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,76.72,,,123.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,130.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,24.25,,,24.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,64.39,290.25,
HC PR 99140 EMERGENCY ANESTHESIA,Px00096310209,CDM,99140,CPT,963,RC,,,,BOTH,,,171,153.9,95.76,,,153.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,50.5,,,133.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.88,,,142.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.88,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.88,,,142.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.37,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.5,,,153.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,164.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.34,,,133.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.37,,,133.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,0.01,,,157.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.23,,,87.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,97.47,,,145.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,95.76,,,153.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,162.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,40.42,,,40.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.37,290.25,
HC PR ED 99292 CRITICAL CARE ADDL 30 MIN CDM,Px00098110023,CDM,99292,CPT,981,RC,,,,OUTPATIENT,,,254,228.6,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.36,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.75,,,211.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.4,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.73,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.7,,,243.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,198.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,198.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,144.78,,,233.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.05,,,129.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.16,,,215.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.24,,,228.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,241.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.96,,,102.96,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,102.96,290.25,
HC PR 99235 HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN CDM,Px00098710025,CDM,99235,CPT,987,RC,,,,BOTH,,,386,347.4,216.16,,,347.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.91,,,301.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.25,,,316.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.25,,,179.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.25,,,316.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.5,,,179.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.6,,,347.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,212.3,,,225.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,301.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,301.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.02,,,355.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.08,,,196.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.02,,,328.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.16,,,347.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,366.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,290.25,
HC PR ED 99285 VISIT HIGH MDM CDM,Px00098110016,CDM,99285,CPT,981,RC,,,,OUTPATIENT,,,413,371.7,231.28,,,371.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.24,,,322.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.13,,,343.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.13,,,210.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.13,,,343.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.68,,,210.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.98,,,371.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,227.15,,,396.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,322.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,322.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.41,,,379.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.91,,,210.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.02,,,351.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.28,,,371.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,392.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,290.25,
HC PR 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES CDM,Px00098710007,CDM,99223,CPT,987,RC,,,,BOTH,,,462,415.8,258.72,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.05,,,360.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,374.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,194.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,374.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,194.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.94,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.1,,,270.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,360.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.34,,,425.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,173.08,,,235.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.34,,,392.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,438.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,290.25,
HC PR 99236 HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN CDM,Px00098710026,CDM,99236,CPT,987,RC,,,,BOTH,,,494,444.6,276.64,,,444.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,233.27,,,385.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.75,,,406.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.75,,,233.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.75,,,406.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.51,,,233.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.25,,,444.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,271.7,,,290.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,385.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,385.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.58,,,454.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.45,,,251.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.58,,,419.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.64,,,444.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,469.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,139.72,,,139.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,139.72,290.25,
HC PR 92950 CARDIOPULMONARY RESUSCITATION,Px00098700001,CDM,92950,CPT,987,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,357.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,357.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.63,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.75,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,412.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,180.59,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,175.33,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,175.33,290.25,
HC PR ED 92950 CARDIOPULMONARY RESUSCITATION CDM,Px00098110596,CDM,92950,CPT,981,RC,,,,OUTPATIENT,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,357.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,357.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.63,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.75,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,412.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,180.59,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.33,,,175.33,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,175.33,290.25,
HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM,Px00098110021,CDM,99291,CPT,981,RC,,,,OUTPATIENT,,,508,457.2,284.48,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.59,,,396.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,417.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,237.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,417.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.65,,,237.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.72,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,279.4,,,297.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,396.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,396.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.56,,,467.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.95,,,258.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.32,,,431.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,284.48,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.25,,,482.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,205.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,205.78,290.25,
HC PR ED 51102 DRAIN BL W/CATH INSERTION CDM,Px00098110394,CDM,51102,CPT,981,RC,,,,OUTPATIENT,,,1015,913.5,568.4,,,913.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.59,,,791.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,634.38,,,844.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,634.38,,,517.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,634.38,,,844.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157,,,517.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.98,,,913.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,558.25,,,974.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.52,,,791.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.52,,,791.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.55,,,933.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.62,,,517.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.55,,,862.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,568.4,,,913.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,964.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.52,,,136.52,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,136.52,290.7,
HC HLA I TYPING  LOW RESOLUTION  ONE ANTIGEN,Px00030017051,CDM,81374,CPT,300,RC,,,,BOTH,,,304,273.6,288.8,,,273.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.12,,,237.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,253.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,154.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,253.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.96,,,154.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,273.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.84,,,291.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,237.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.45,,,237.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,279.68,,,279.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.96,,,154.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.4,,,258.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.8,,,273.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,273.6,,,288.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,148.96,,,148.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,237.12,291.84,
HC PR 11043 DEB MUSC/FASCIA 20 SQ CM /<,Px00097510465,CDM,11043,CPT,975,RC,,,,BOTH,,,362,325.8,202.72,,,325.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.07,,,282.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,313.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,313.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.72,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,184.77,,,325.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.1,,,213.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.32,,,282.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.32,,,282.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.34,,,333.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.8,,,184.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.34,,,307.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.72,,,325.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.05,,,343.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.32,,,149.32,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,149.32,292.05,
HC TCC-EZ CASTING BOOT LARGE,Sx000TCC21114,CDM,,,270,RC,,,,BOTH,,,304.6,274.14,289.37,,,274.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.59,,,237.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.14,,,253.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.14,,,155.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.14,,,253.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.25,,,155.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.14,,,274.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.42,,,292.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.88,,,237.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.75,,,237.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.23,,,280.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.25,,,155.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.91,,,258.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.37,,,274.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.14,,,289.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,149.25,,,149.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,237.59,292.42,
HC RECOVERY CLASS IV - ADDL 15 MIN,Px00071010121,CDM,,,710,RC,,,,BOTH,,,308,277.2,292.6,,,277.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.24,,,240.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,256.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,156.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,256.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.92,,,156.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,277.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,295.68,,,295.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,240.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,150.92,,,240.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.36,,,283.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.92,,,156.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.8,,,261.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.6,,,277.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.2,,,292.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,150.92,,,150.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,240.24,295.68,
TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),Rx23155052441,CDM,,,250,RC,23155-0524-41,NDC,,BOTH,10,ML,310.29,279.26,294.78,,,294.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,242.03,,,242.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,279.26,,,279.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,279.26,,,279.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,279.26,,,279.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.04,,,152.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,279.26,,,279.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,297.88,,,297.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,228.06,,,228.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,153.56,,,153.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,285.47,,,285.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.04,,,152.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,263.75,,,263.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,294.78,,,294.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,279.26,,,279.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,152.04,,,152.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,242.03,297.88,
TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),Rx23155052431,CDM,,,250,RC,23155-0524-31,NDC,,BOTH,10,ML,310.29,279.26,294.78,,,279.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.03,,,242.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.26,,,258.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.26,,,158.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.26,,,258.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.04,,,158.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,279.26,,,279.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.88,,,297.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,228.06,,,242.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,153.56,,,242.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.47,,,285.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.04,,,158.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.75,,,263.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.78,,,279.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.26,,,294.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.04,,,152.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,242.03,297.88,
HC SCREW BONE 2.3X16MM SELF-TAP CROSSPIN,Sx0058-23016E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,312,280.8,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.36,,,243.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.41,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.04,,,287.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,265.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,296.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,243.36,299.52,
HC SCREW BONE 2.3X18MM SELF-TAP CROSSPIN,Sx0058-23018E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,312,280.8,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.36,,,243.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.41,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.04,,,287.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,265.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,296.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,243.36,299.52,
HC SCREW BONE 1.7X16MM SELF TAP CROSS PIN,Sx0058-17016E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,312,280.8,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.36,,,243.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,259.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,154.41,,,243.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.04,,,287.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,265.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.4,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,296.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,152.88,,,152.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,243.36,299.52,
HC PR ED 36556 INSERT NON-TUNNEL CV CATH > 5 CDM,Px00098110494,CDM,36556,CPT,981,RC,,,,OUTPATIENT,,,197,177.3,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.94,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.24,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.72,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.35,,,189.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.29,,,181.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.62,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.29,,,167.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,187.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,80.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.21,299.7,
HC PR 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>  CDM,Px00097514056,CDM,36556,CPT,975,RC,,,,BOTH,,,197,177.3,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.94,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.24,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.72,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.38,,,189.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.38,,,181.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.62,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.29,,,167.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,187.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,80.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.21,299.7,
HC PR 36556 INSERT NON-TUNNEL CV CATH > 5,Px00096310231,CDM,36556,CPT,975,RC,,,,BOTH,,,766,689.4,428.96,,,689.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.94,,,597.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.75,,,637.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.75,,,390.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.75,,,637.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.24,,,390.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.72,,,689.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.3,,,735.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,597.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,597.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.62,,,704.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.62,,,390.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.62,,,651.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.96,,,689.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,727.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.21,,,80.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.21,299.7,
HC PR 28010 INCISION OF TOE TENDON,Px00097510473,CDM,28010,CPT,975,RC,,,,BOTH,,,557,501.3,311.92,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.88,,,434.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,463.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,463.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.36,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,249.2,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,306.35,,,534.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.88,,,434.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.88,,,434.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.49,,,512.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.18,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.49,,,473.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.92,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,529.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,209.88,,,209.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,209.88,299.7,
HC PR ED 69020 DRAIN OUTER EAR CANAL LESION CDM,Px00098110829,CDM,69020,CPT,981,RC,,,,OUTPATIENT,,,574,516.6,321.44,,,516.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.93,,,447.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.75,,,477.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.75,,,292.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.75,,,477.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,164.55,,,292.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.82,,,516.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.7,,,551.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.09,,,447.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.09,,,447.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.18,,,528.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.38,,,292.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.18,,,487.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,321.44,,,516.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,300.14,,,545.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.09,,,143.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,143.09,300.14,
ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT),Rx42023022101,CDM,J1335,HCPCS,636,RC,42023022101,NDC,,BOTH,1,GR,312.82,281.54,297.18,,,297.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,244,,,244,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,281.54,,,281.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,281.54,,,281.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,281.54,,,281.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,153.28,,,153.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,281.54,,,281.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,300.31,,,300.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,229.92,,,229.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,153.28,,,153.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,287.79,,,287.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,153.28,,,153.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,265.9,,,265.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,297.18,,,297.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,281.54,,,281.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,153.28,,,153.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,244,300.31,
HC PR ED 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM,Px00098110280,CDM,12041,CPT,981,RC,,,,OUTPATIENT,,,339,305.1,189.84,,,305.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.12,,,264.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.88,,,282.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.88,,,172.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.88,,,282.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,165.27,,,172.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,179.59,,,305.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.45,,,325.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.71,,,264.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,143.71,,,264.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.23,,,311.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.02,,,172.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.23,,,288.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.84,,,305.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.5,,,322.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.71,,,143.71,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,143.71,301.5,
HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM,Px00098110274,CDM,12031,CPT,981,RC,,,,OUTPATIENT,,,615,553.5,344.4,,,553.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.62,,,479.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,384.38,,,511.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,384.38,,,313.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,384.38,,,511.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.22,,,313.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.02,,,553.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,338.25,,,590.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.76,,,479.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,149.76,,,479.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.55,,,565.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,154.25,,,313.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.55,,,522.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.4,,,553.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.5,,,584.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.76,,,149.76,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,149.76,301.5,
HC SCREW BONE T10 3.5X42MM IMPLNT,Sx00040-35042,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,314.4,282.96,298.68,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.23,,,245.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,261.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,160.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,261.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,160.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.82,,,301.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.08,,,245.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.6,,,245.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.25,,,289.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,160.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.24,,,267.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.68,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,298.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,154.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,245.23,301.82,
HC SCREW BONE 3.5 X 50MM IMPL,Sx00040-35050,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,314.4,282.96,298.68,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.23,,,245.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,261.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,160.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,261.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,160.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.82,,,301.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.08,,,245.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.6,,,245.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.25,,,289.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,160.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.24,,,267.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.68,,,282.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.96,,,298.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.06,,,154.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,245.23,301.82,
HC TRIMANO BEACH CHAIR KIT  INMINIMUM ORDER OF 6EA,Sx0000AR-1644,CDM,,,270,RC,,,,BOTH,,,315,283.5,299.25,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.7,,,245.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,262.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,160.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,262.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,160.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.53,,,245.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.89,,,245.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.8,,,289.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,160.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.75,,,267.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.25,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,299.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,154.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,245.7,302.4,
HC XR ENTIRE SPINE 4 OR 5 VIEWS,Px00032010606,CDM,72083,CPT,320,RC,,,,BOTH,,,315,283.5,299.25,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.7,,,245.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,262.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,160.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,262.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,160.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.53,,,245.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,155.89,,,245.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.8,,,289.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,160.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.75,,,267.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.25,,,283.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.5,,,299.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.35,,,154.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,245.7,302.4,
COLLAGENASE OINT 250 UNIT/GM,Rx50484001030,CDM,,,250,RC,50484-0010-30,NDC,,BOTH,1,GR,315.89,270.86,300.1,,,284.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.39,,,246.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.3,,,263.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.3,,,161.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.3,,,263.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.79,,,161.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,284.3,,,284.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.25,,,303.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.18,,,246.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.33,,,246.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.62,,,290.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.79,,,161.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.51,,,268.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.1,,,284.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.3,,,300.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,154.79,,,154.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,246.39,303.25,
HC BLADE AGGRESSIVE PLUS 5.5MM,Sx375-564-000,CDM,,,270,RC,,,,BOTH,,,318.04,106.65,302.14,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.07,,,248.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,264.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,162.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,264.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,162.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.32,,,305.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.76,,,248.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.4,,,248.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,292.6,,,292.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,162.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.33,,,270.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.14,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,302.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,155.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,248.07,305.32,
HC BLADE SHAVER SM JOINT 2.5MM F-SER,Sx0375-628-00,CDM,,,270,RC,,,,BOTH,,,318.04,237.16,302.14,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.07,,,248.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,264.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,162.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,264.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,162.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.32,,,305.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.76,,,248.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,157.4,,,248.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,292.6,,,292.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,162.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.33,,,270.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.14,,,286.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.24,,,302.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,155.84,,,155.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,248.07,305.32,
SARGRAMOSTIM LYOPHILIZED FOR INJ 250 MCG,Rx71837584301,CDM,J2820,HCPCS,636,RC,71837584301,NDC,,BOTH,0.25,ML,319.5,287.55,303.53,,,287.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.21,,,249.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.55,,,265.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.55,,,162.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.55,,,265.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.56,,,162.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.55,,,287.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.72,,,306.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.83,,,249.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.56,,,249.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.94,,,293.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.56,,,162.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,271.58,,,271.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.53,,,287.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.55,,,303.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.56,,,156.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,249.21,306.72,
HC TCC-EZ CASTING BOOT  X-LARGE,Sx000TCC21124,CDM,,,270,RC,,,,BOTH,,,319.68,287.71,303.7,,,287.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.35,,,249.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.71,,,266.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.71,,,162.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.71,,,266.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.64,,,162.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.71,,,287.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.89,,,306.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.96,,,249.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.21,,,249.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.11,,,294.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.64,,,162.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,271.73,,,271.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.7,,,287.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.71,,,303.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.64,,,156.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,249.35,306.89,
HC TIXAGEVIMAB AND CILGAVIMAB (EVUSHELD) INJECTION M0220,Px00026000010,CDM,M0220,CPT,260,RC,,,,BOTH,,,320,288,304,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.6,,,249.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,266.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,163.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,266.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.8,,,163.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,288,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.2,,,307.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,249.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.37,,,249.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.4,,,294.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.8,,,163.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272,,,272,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304,,,288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288,,,304,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,156.8,,,156.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,249.6,307.2,
DIPHTHERIA-TETANUS TOX ADSORBED (DT) IM INJ 25-5 UNIT/0.5ML,Rx49281022558,CDM,90702,CPT,636,RC,49281022558,NDC,,BOTH,0.5,ML,323.16,290.84,307,,,307,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,252.06,,,252.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,290.84,,,290.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,290.84,,,290.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,290.84,,,290.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,158.35,,,158.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,290.84,,,290.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,310.23,,,310.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,237.52,,,237.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,158.35,,,158.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,297.31,,,297.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,158.35,,,158.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,274.69,,,274.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,307,,,307,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,290.84,,,290.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,158.35,,,158.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.06,310.23,
PROCAINAMIDE HCL INJ 100 MG/ML,Rx76329339905,CDM,J2690,HCPCS,636,RC,76329339905,NDC,,BOTH,1,ML,323.59,291.41,307.41,,,291.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.4,,,252.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.23,,,269.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.23,,,164.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.23,,,269.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.56,,,164.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.23,,,291.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,310.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.84,,,252.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.56,,,252.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,297.7,,,297.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.56,,,164.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.05,,,275.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.41,,,291.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.23,,,307.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.56,,,158.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.4,310.65,
HC IN SITU HYBRIDIZATION SENDOUT,Px00030011689,CDM,88365,CPT,300,RC,,,,BOTH,,,324,291.6,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.72,,,252.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,165.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.04,,,311.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.4,,,275.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,158.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.72,311.04,
HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,Px00032010330,CDM,77001,CPT,320,RC,,,,BOTH,,,324,291.6,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.72,,,252.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,165.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.04,,,311.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.4,,,275.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,158.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.72,311.04,
HC OT EVALUATION LOW COMPLEX,Px00043410045,CDM,97165,CPT,434,RC,,,,BOTH,,,324,291.6,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.72,,,252.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,165.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.04,,,311.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.4,,,275.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,158.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.72,311.04,
HC OT EVALUATION MOD COMPLEXITY,Px00043410046,CDM,97166,CPT,434,RC,,,,BOTH,,,324,291.6,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.72,,,252.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,165.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.04,,,311.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.4,,,275.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,158.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.72,311.04,
HC OT EVALUATION HIGH COMPLEX,Px00043410047,CDM,97167,CPT,434,RC,,,,BOTH,,,324,291.6,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.72,,,252.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,165.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,269.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.04,,,311.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.35,,,252.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,165.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,275.4,,,275.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,291.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.6,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,158.76,,,158.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,252.72,311.04,
HC PR G0105 COLORECTAL SCRN; HI RISK IND   CDM,Px00097514117,CDM,G0105,CPT,975,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.76,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.21,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.57,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,412.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.51,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,177.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,177.57,311.51,
HC PR G0105 COLORECTAL SCRN; HI RISK IND,Px00097510012,CDM,G0105,CPT,975,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.76,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.21,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.57,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,412.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.51,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,177.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,177.57,311.51,
HC PR G0121 COLORECTAL SCRN; NOT HI RISK IND   CDM,Px00097514116,CDM,G0121,CPT,975,RC,,,,BOTH,,,431,387.9,241.36,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.96,,,336.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,355.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,205.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,355.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.5,,,205.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.88,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.05,,,413.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,336.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,336.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.67,,,396.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.16,,,219.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.67,,,366.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.36,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.51,,,409.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,177.83,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,177.83,311.51,
HC PR G0121 COLORECTAL SCRN; NOT HI RISK IND,Px00097510013,CDM,G0121,CPT,975,RC,,,,BOTH,,,431,387.9,241.36,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,148.96,,,336.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,355.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,205.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.38,,,355.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.5,,,205.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.88,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.05,,,413.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,336.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,336.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.67,,,396.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.16,,,219.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.67,,,366.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.36,,,387.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.51,,,409.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.83,,,177.83,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,177.83,311.51,
HC MAMMO DIAG UNI W CAD,Px00040110005,CDM,77065,CPT,401,RC,,,,BOTH,,,326,293.4,309.7,,,233.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.28,,,254.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,216.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,166.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,216.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.96,,,312.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.34,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.92,,,299.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.1,,,277.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.7,,,233.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,309.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,159.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,254.28,312.96,
HC PT EVALUATION LOW COMPLEX,Px00042410066,CDM,97161,CPT,420,RC,,,,BOTH,,,326,293.4,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.28,,,254.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,166.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.96,,,312.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.34,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.92,,,299.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.1,,,277.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,309.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,159.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,254.28,312.96,
HC PT EVALUATION  MOD COMPLEX,Px00042410067,CDM,97162,CPT,424,RC,,,,BOTH,,,326,293.4,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.28,,,254.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,166.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.96,,,312.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.34,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.92,,,299.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.1,,,277.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,309.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,159.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,254.28,312.96,
HC PT EVALUATION HIGH COMPLEX,Px00042410068,CDM,97163,CPT,424,RC,,,,BOTH,,,326,293.4,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.28,,,254.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,166.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,271.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.96,,,312.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.34,,,254.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.92,,,299.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,166.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.1,,,277.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.7,,,293.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.4,,,309.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,159.74,,,159.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,254.28,312.96,
HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,Px00046010055,CDM,94010,CPT,460,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,289.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,289.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,47.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC THREADED PEG LOCKING 2.3X19MM PINK,SxTPLS-23190-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL LOCKING 3.5X12 BRONZE,SxCOLS-35120-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL NON LOCK 3.5X12 BLUE,SxPANL-35120-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL NON LOCK 3.5X13 BLUE,SxPANL-35130-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL LOCKING 3.5X9MM EXPLANTED,SxCOLS-35090-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL NON LOCK 3.5X14,SxPANL-35140-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL LOCKING 3.5X10,SxCOLS-35100-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC SCREW CORTICAL NON LOCK 3.5X10,SxPANL-35100-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327,294.3,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.06,,,255.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,166.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,272.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.92,,,313.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.35,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,161.83,,,255.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.84,,,300.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,166.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.95,,,277.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.65,,,294.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.3,,,310.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.23,,,160.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.06,313.92,
HC STAPLER CARTRIDGE RELOAD TCR10,Sx000000TCR10,CDM,,,270,RC,,,,BOTH,,,327.33,299.34,310.96,,,299.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.32,,,259.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.6,,,276.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.6,,,169.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.6,,,276.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.39,,,169.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.6,,,299.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.24,,,319.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.59,,,259.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162,,,259.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,301.14,,,305.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.39,,,169.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,278.23,,,282.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.96,,,299.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.6,,,315.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.39,,,160.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.32,314.24,
HC K-WIRE 2MM W/STOP FOR T10 SCREW HEAD,Sx00000703818,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,327.6,294.84,311.22,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.53,,,255.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,272.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,166.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,272.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,166.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.5,,,314.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,240.79,,,255.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.13,,,255.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,301.39,,,301.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,166.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.22,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,311.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,160.52,,,160.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,255.53,314.5,
HC SCREW LOW PROFILE CORTEX 2.4X26MM,Sx0AR-8724-26,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,330,297,313.5,,,297,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.4,,,257.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297,,,274.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297,,,168.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297,,,274.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,168.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,297,,,297,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,257.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.32,,,257.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.6,,,303.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,168.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.5,,,280.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.5,,,297,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297,,,313.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,161.7,,,161.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,257.4,316.8,
HC STRAPPING UNNA BOOT,Px00076110462,CDM,29580,CPT,761,RC,,,,BOTH,,,331,297.9,314.45,,,297.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.18,,,258.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.9,,,275.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.9,,,168.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.9,,,275.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.19,,,168.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,297.9,,,297.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.76,,,317.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.29,,,258.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.19,,,258.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.52,,,304.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.19,,,168.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.35,,,281.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.45,,,297.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.9,,,314.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.19,,,162.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.18,317.76,
HC SCREW BONE T10 3.5X16MM IMPL,Sx00040-35016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,331.2,298.08,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,258.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,168.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.95,,,317.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.43,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.7,,,304.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.52,,,281.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,162.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.34,317.95,
HC SCREW BONE T10 3.5X18MM IMPLNT,Sx00040-35018,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,331.2,298.08,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,258.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,168.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.95,,,317.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.43,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.7,,,304.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.52,,,281.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,162.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.34,317.95,
HC SCREW BONE T10 3.5X22MM IMPLNT,Sx00040-35022,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,331.2,298.08,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,258.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,168.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.95,,,317.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.43,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.7,,,304.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.52,,,281.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,162.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.34,317.95,
HC SCREW BONE T10 3.5X12MM,Sx00040-35020,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,331.2,298.08,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,258.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,168.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,275.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.95,,,317.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.43,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.91,,,258.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.7,,,304.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,168.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.52,,,281.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,298.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.08,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.29,,,162.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.34,317.95,
HC DRILL BIT 3.5MM,Sx0AR-4160-35,CDM,,,270,RC,,,,BOTH,,,331.8,298.62,315.21,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.8,,,258.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,276.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,169.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,276.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,169.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.53,,,318.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.87,,,258.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.21,,,258.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.26,,,305.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,169.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.03,,,282.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.21,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,315.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,162.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.8,318.53,
HC DRILL BIT 1.7MM,Sx0AR-8916-14,CDM,,,270,RC,,,,BOTH,,,331.8,298.62,315.21,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.8,,,258.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,276.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,169.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,276.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,169.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.53,,,318.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,243.87,,,258.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.21,,,258.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.26,,,305.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,169.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.03,,,282.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.21,,,298.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.62,,,315.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.58,,,162.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.8,318.53,
HC APPLICATION CAST HAND & LOWER FOREARM GAUNTLET,Px00076110589,CDM,29085,CPT,761,RC,,,,BOTH,,,332,298.8,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.96,,,258.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,292.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,292.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.72,,,91.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.02,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.44,,,305.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,169.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.2,,,282.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,315.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,162.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.96,318.72,
HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,Px00076110464,CDM,29581,CPT,761,RC,,,,BOTH,,,332,298.8,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.96,,,258.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,276.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,169.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,276.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,169.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.72,,,318.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.02,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.44,,,305.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,169.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.2,,,282.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,315.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,162.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.96,318.72,
HC HEPATITIS ACUTE PANEL,Px00030112029,CDM,80074,CPT,300,RC,,,,BOTH,,,332,298.8,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.96,,,258.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,276.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,169.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,276.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,169.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.72,,,318.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.02,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.31,,,258.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.44,,,305.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,169.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.2,,,282.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.4,,,298.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298.8,,,315.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,162.68,,,162.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,258.96,318.72,
HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,Px00046010092,CDM,94010,CPT,460,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,293.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,293.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,47.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,Px00046010030,CDM,94010,CPT,460,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,293.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,293.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,47.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
"HC VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)",Px00046010090,CDM,94150,CPT,460,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC RESPIRATORY FLOW VOLUME LOOP,Px00046010053,CDM,94375,CPT,460,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOR OTH,Px00046010024,CDM,94727,CPT,460,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC PULMONARY MECHANICS ( I.E.NIF VC RR VT),Px00041010008,CDM,94150,CPT,410,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.8,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC PULSE OXIMETRY NOCTURNAL STUDY,Px00041010013,CDM,94762,CPT,410,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.8,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC CARBOGEN TREATMENT INITIAL SET UP,Px00041010233,CDM,94799,CPT,410,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.8,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC MECHANICAL VENTILATION SWITCH ENTIRE VENTILATOR,Px00041010301,CDM,94799,CPT,410,RC,,,,BOTH,,,333,299.7,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.74,,,259.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,169.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,277.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.68,,,319.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,244.76,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,164.8,,,259.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.36,,,306.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,169.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.05,,,283.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.35,,,299.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.7,,,316.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.17,,,163.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,259.74,319.68,
HC ED APPLICATION OF FINGER SPLINT STATIC CDM,Px00045013112,CDM,29130,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,38.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED SHORT ARM SPLINT APPLICATION CDM,Px00045013110,CDM,29125,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,53.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED DIAGNOSTIC ANOSCOPY CDM,Px00045010414,CDM,46600,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,55.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED CONTROL OF NOSEBLEED SIMPLE CDM,Px00045010028,CDM,30901,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,77.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED APPLICATION SHORT ARM SPLINT DYNAMIC CDM,Px00045010825,CDM,29126,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED STRAPPING OF KNEE CDM,Px00045013135,CDM,29530,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED CONTROL OF NOSEBLEED COMPLEX CDM,Px00045010030,CDM,30903,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED CONTROL OF NOSEBLEED POSTERIOR CDM,Px00045013183,CDM,30905,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM,Px00045010081,CDM,36591,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM,Px00045010083,CDM,36600,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED REPAIR TONGUE LACRTN <2.6CM  FLOOR OF MOUTH AND/OR ANTERIOR TWO-T CDM,Px00045013224,CDM,41250,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED DRAINAGE OF GUM LESION CDM,Px00045010492,CDM,41800,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED INSJ NON-NDWELLG BLADDER CATHETER CDM,Px00045010219,CDM,51701,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM,Px00045013170,CDM,65222,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,147.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,241.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC ED INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE CDM,Px00045010223,CDM,51702,CPT,450,RC,,,,OUTPATIENT,,,334,237.6,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.52,,,226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,263.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.64,,,278.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.28,,,266.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,147.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,283.9,,,246.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.6,,,275.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,163.66,,,163.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,260.52,320.64,
HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/>,Px00096310232,CDM,36569,CPT,975,RC,,,,BOTH,,,217,195.3,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.74,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.82,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.83,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.35,,,208.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,199.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.99,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,184.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,320.84,,,206.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,341.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,341.03,320.84,
HC PR 36569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>  CDM,Px00097514058,CDM,36569,CPT,975,RC,,,,BOTH,,,217,195.3,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.74,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.82,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.83,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.2,,,208.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.2,,,199.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.99,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,184.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,320.84,,,206.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,341.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,341.03,320.84,
HC PR ED 36569 INSERTION PICC W/O IMG GDN 5 YR/> CDM,Px00098110496,CDM,36569,CPT,981,RC,,,,OUTPATIENT,,,217,195.3,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.74,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.63,,,180.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,392.18,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.83,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.35,,,208.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,169.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,199.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,351.26,,,110.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.69,,,184.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.52,,,195.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,320.84,,,206.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.03,,,341.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,341.03,320.84,
HC PR 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN CDM,Px00098700002,CDM,99291,CPT,987,RC,,,,BOTH,,,508,457.2,284.48,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.59,,,396.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,417.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,237.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.5,,,417.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.65,,,237.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.72,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,279.4,,,297.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,396.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,396.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.56,,,467.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.95,,,258.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.56,,,431.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,284.48,,,457.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,321.5,,,482.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.78,,,205.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,205.78,321.5,
HC US FETAL BIOPHYS PROFILE W/O NST,Px00040210026,CDM,76819,CPT,402,RC,,,,BOTH,,,336,302.4,319.2,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.08,,,262.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,279.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,171.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,279.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,171.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.56,,,322.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,262.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.29,,,262.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.12,,,309.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,171.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.6,,,285.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.2,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,319.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,164.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,262.08,322.56,
HC PR 99465 CRITICAL CARE - NEWBORN,Px00096910634,CDM,99465,CPT,410,RC,,,,BOTH,,,336,302.4,319.2,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.08,,,262.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,279.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,171.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,279.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,171.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.56,,,322.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,262.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.29,,,262.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.12,,,309.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,171.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.6,,,285.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.2,,,302.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.4,,,319.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,164.64,,,164.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,262.08,322.56,
HC ED DRAIN BLOOD FROM UNDER NAIL CDM,Px00045010609,CDM,11740,CPT,450,RC,,,,OUTPATIENT,,,337,239.4,320.15,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.86,,,228.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,265.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,265.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.52,,,44.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,247.7,,,228.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.78,,,228.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.04,,,269.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,149.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,286.45,,,249.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.15,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,278.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,165.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,262.86,323.52,
HC ED REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM,Px00045010467,CDM,65205,CPT,450,RC,,,,OUTPATIENT,,,337,239.4,320.15,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.86,,,228.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,243.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,149.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,243.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,149.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.52,,,281.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,247.7,,,228.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.78,,,228.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.04,,,269.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,149.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,286.45,,,249.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.15,,,263.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.3,,,278.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.13,,,165.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,262.86,323.52,
DIPHTHERIA-TETANUS TOX ADSORBED (DT) IM INJ 25-5 UNIT/0.5ML,Rx49281022510,CDM,90702,CPT,636,RC,49281022510,NDC,,BOTH,0.5,ML,337.74,303.97,320.85,,,320.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.44,,,263.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.97,,,303.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.97,,,303.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.97,,,303.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,165.49,,,165.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,303.97,,,303.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,324.23,,,324.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,248.24,,,248.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,165.49,,,165.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,310.72,,,310.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,165.49,,,165.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,287.08,,,287.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,320.85,,,320.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.97,,,303.97,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,165.49,,,165.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,263.44,324.23,
HC INFLUENZA A-B PCR,Px00030211511,CDM,87502,CPT,300,RC,,,,BOTH,,,338,304.2,321.1,,,304.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.64,,,263.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.2,,,281.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.2,,,172.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.2,,,281.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.62,,,172.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.2,,,304.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.48,,,324.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.43,,,263.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,167.28,,,263.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.96,,,310.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.62,,,172.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.3,,,287.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.1,,,304.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.2,,,321.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,165.62,,,165.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,263.64,324.48,
HC RECOVERY CLASS V - ADDL 15 MIN,Px00071010125,CDM,,,710,RC,,,,BOTH,,,339,305.1,322.05,,,305.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.42,,,264.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.1,,,282.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.1,,,172.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.1,,,282.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.11,,,172.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.1,,,305.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.44,,,325.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.17,,,264.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.11,,,264.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,311.88,,,311.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.11,,,172.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,288.15,,,288.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.05,,,305.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.1,,,322.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.11,,,166.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,264.42,325.44,
MEDROXYPROGESTERONE ACETATE IM SUSP PREFILLED SYR 150 MG/ML,Rx00009737611,CDM,J1050,HCPCS,636,RC,9737611,NDC,,BOTH,1,ML,339.99,306.23,322.99,,,306.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.19,,,265.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.99,,,298.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.99,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.99,,,298.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.99,,,306.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.39,,,340.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.89,,,265.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,265.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,312.79,,,312.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,173.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,288.99,,,289.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.99,,,306.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.99,,,323.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,265.19,326.39,
HC ED CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM,Px00045010489,CDM,69200,CPT,450,RC,,,,OUTPATIENT,,,340,242.1,323,,,266.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,230.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,267.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,267.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,266.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,79.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,230.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.27,,,230.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,312.8,,,272.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,150.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289,,,251.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323,,,266.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,281.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,265.2,326.4,
HC SAGITTAL BLADE 90X25.4X1.27,SxAR-600-305S,CDM,,,270,RC,,,,BOTH,,,340,306,323,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,265.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,283.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,173.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,283.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,173.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,265.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.27,,,265.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,312.8,,,312.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,173.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289,,,289,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,265.2,326.4,
HC BB TAK THREADED,Sx00AR-13226T,CDM,,,270,RC,,,,BOTH,,,340,306,323,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.2,,,265.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,283.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,173.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,283.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,173.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,265.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,168.27,,,265.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,312.8,,,312.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,173.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289,,,289,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306,,,323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,166.6,,,166.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,265.2,326.4,
HC PR 45331 SIGMOIDOSCOPY AND BIOPSY,Px00097510759,CDM,45331,CPT,975,RC,,,,BOTH,,,707,636.3,395.92,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.43,,,551.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,518.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,81.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,518.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.14,,,81.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.01,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.85,,,102.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,551.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,551.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.99,,,650.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,72.68,,,360.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.99,,,600.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.92,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.15,,,671.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,70.56,,,70.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,70.56,327.15,
HC THREADED PEG LOCKING 2.3X20MM PINK,SxTPLS-23200-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,342,307.8,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,266.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,174.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.32,,,328.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.37,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.26,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,290.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,324.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,167.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,266.76,328.32,
HC THREADED PEG LOCKING 2.3X22MM PINK,SxTPLS-23220-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,342,307.8,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,266.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,174.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.32,,,328.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.37,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.26,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,290.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,324.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,167.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,266.76,328.32,
HC THREADED PEG LOCKING 2.3X20MM EXPLANTED,SxTPLS-23200-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,342,307.8,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,266.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,174.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.32,,,328.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.37,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.26,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,290.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,324.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,167.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,266.76,328.32,
HC SCREW CORTICAL LOCKING 3.5X11,SxCOLS-35110-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,342,307.8,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,266.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,174.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.32,,,328.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.37,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.26,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,290.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,324.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,167.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,266.76,328.32,
HC SCREW CORTICAL NON LOCK 3.5X11,SxPANL-35110-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,342,307.8,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.76,,,266.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,174.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,284.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.32,,,328.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.37,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.26,,,266.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.64,,,314.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,174.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,290.7,,,290.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.9,,,307.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.8,,,324.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.58,,,167.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,266.76,328.32,
HC CENTAL VENOUS CATHETER,Px00000139WNH,CDM,,,270,RC,,,,BOTH,,,342.44,308.2,325.32,,,308.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.1,,,267.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.2,,,285.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.2,,,174.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.2,,,285.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.8,,,174.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.2,,,308.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.74,,,328.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.69,,,267.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.47,,,267.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,315.04,,,315.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.8,,,174.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.07,,,291.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.32,,,308.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.2,,,325.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,167.8,,,167.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,267.1,328.74,
HC PR ED 12051 INTMD WND REPAIR FACE/UP TO 2.5CM CDM,Px00098110616,CDM,12051,CPT,981,RC,,,,OUTPATIENT,,,394,354.6,220.64,,,354.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,217.17,,,307.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,246.25,,,327.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,246.25,,,200.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,246.25,,,327.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.89,,,200.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.9,,,354.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.7,,,378.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.86,,,307.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.86,,,307.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224.58,,,362.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,171.87,,,200.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224.58,,,334.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.64,,,354.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.95,,,374.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.86,,,166.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,166.86,328.95,
HC PR 58120 DILATION AND CURETTAGE,Px00097511079,CDM,58120,CPT,975,RC,,,,BOTH,,,557,501.3,311.92,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.8,,,434.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,463.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.13,,,463.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.04,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.38,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,306.35,,,534.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.73,,,434.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.73,,,434.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.49,,,512.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.59,,,283.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.49,,,473.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.92,,,501.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,329.4,,,529.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.73,,,228.73,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,228.73,329.4,
HC SCREW LOCKING 3.5X16MM LOW PROFILE,Sx000AR-8835L,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC HEX CORTICAL SCREW 3.2X10MM,Sx000HEX3.2-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC HEX CORTICAL SCREW 3.2X12MM,Sx00HEX3.2-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC HEX CORTICAL SCREW 3.2X14MM,Sx00HEX3.2-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC HEX CORTICAL SCREW 3.2X16MM,Sx00HEX3.2-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC LO-PRO LOCK SCREW 2.7X16MM SS,SxAR-8827L-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC LO-PRO LOCK SCREW 2.7X18MM SS,SxAR-8827L-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC LO-PRO LOCK SCREW 3.5X12MM SS,SxAR-8835L-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC SUTURETAPE 2.0MM MENISCUS REPAIR NEEDLES,Sx0000AR-7523,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,345,310.5,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.1,,,269.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,175.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,287.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,253.58,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.74,,,269.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.4,,,317.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,175.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,293.25,,,293.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.75,,,310.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.5,,,327.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,169.05,,,169.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,269.1,331.2,
HC PR ED 28475 CLOSED TREAT METATARSAL FRACTURE W/MANIP CDM,Px00098110438,CDM,28475,CPT,981,RC,,,,OUTPATIENT,,,535,481.5,299.6,,,481.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.83,,,417.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.38,,,445.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.38,,,272.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.38,,,445.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.18,,,272.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.29,,,481.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,294.25,,,513.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.07,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.07,,,417.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.95,,,492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.09,,,272.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.95,,,454.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.6,,,481.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.65,,,508.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.07,,,234.07,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,234.07,331.65,
HC SCREW BONE 2.3X14MM SELF-TAP CROSSPIN,Sx0058-23014E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,348,313.2,330.6,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.44,,,271.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,289.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,177.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,289.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,177.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.08,,,334.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,271.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.23,,,271.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.16,,,320.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,177.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,295.8,,,295.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.6,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,330.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,170.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,271.44,334.08,
HC BONE SCREW 2.3X14MM CROSS PIN SELF TAP,Sx0058-23009E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,348,313.2,330.6,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.44,,,271.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,289.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,177.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,289.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,177.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.08,,,334.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,271.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.23,,,271.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.16,,,320.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,177.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,295.8,,,295.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.6,,,313.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.2,,,330.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,170.52,,,170.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,271.44,334.08,
"HC PR 57522 CONIZATION OF CERVIX, LOOP ELECTRODE",Px00097511076,CDM,57522,CPT,975,RC,,,,BOTH,,,728,655.2,407.68,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.59,,,567.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,586.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,293.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,586.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.17,,,293.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,286.04,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.4,,,333.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.45,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,251.45,,,567.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.96,,,669.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.99,,,370.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.96,,,618.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,407.68,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.25,,,691.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.45,,,251.45,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,251.45,335.25,
HC PR ED 25530 TREAT FRACTURE OF ULNA CDM,Px00098110734,CDM,25530,CPT,981,RC,,,,OUTPATIENT,,,579,521.1,324.24,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,323.55,,,451.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,481.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,481.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,294.35,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,282.56,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,318.45,,,555.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.96,,,451.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.96,,,451.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.03,,,532.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.64,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.03,,,492.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.24,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.25,,,550.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.96,,,255.96,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,255.96,335.25,
HC TB TEST CELL IMMUN MEASURE,Px00030210598,CDM,86480,CPT,300,RC,,,,BOTH,,,349.57,314.61,332.09,,,314.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,272.66,,,272.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.61,,,290.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.61,,,178.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.61,,,290.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.29,,,178.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.61,,,314.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.59,,,335.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.93,,,272.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,173,,,272.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.6,,,321.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.29,,,178.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,297.13,,,297.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,332.09,,,314.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.61,,,332.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,171.29,,,171.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,272.66,335.59,
HC PR ED 26010 DRAINAGE OF FINGER ABSCESS - SMPL CDM,Px00098110761,CDM,26010,CPT,981,RC,,,,OUTPATIENT,,,334,300.6,187.04,,,300.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.95,,,260.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.75,,,278.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.75,,,170.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.75,,,278.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.32,,,170.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.8,,,300.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.7,,,320.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.15,,,260.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.15,,,260.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.38,,,307.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.38,,,170.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.38,,,283.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,187.04,,,300.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336.6,,,317.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.15,,,141.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.15,336.6,
HC MAMMO SCREEN BIL W CAD,Px00040310004,CDM,77067,CPT,403,RC,,,,BOTH,,,352,316.8,334.4,,,246.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.56,,,274.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,229.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,179.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,229.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.48,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,337.92,,,337.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.2,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.84,,,323.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.48,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.2,,,299.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.4,,,246.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.8,,,334.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.48,,,172.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,274.56,337.92,
HC BONE SCREW T7 2.3 X 12 MM,Sx0053-23212E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,352.8,317.52,335.16,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.18,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,293.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,179.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,293.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,179.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,338.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.31,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.58,,,324.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,179.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.88,,,299.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,335.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,172.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,275.18,338.69,
HC BONE SCREW T7 2.7 X 16MM,Sx0053-27216E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,352.8,317.52,335.16,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.18,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,293.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,179.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,293.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,179.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,338.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.31,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.58,,,324.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,179.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.88,,,299.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,317.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,335.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.87,,,172.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,275.18,338.69,
HC US OB LIMITED FETUS(S),Px00040210022,CDM,76815,CPT,402,RC,,,,BOTH,,,353,317.7,335.35,,,317.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.34,,,275.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,293.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,179.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,293.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.97,,,179.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,317.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.88,,,338.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.46,,,275.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,174.7,,,275.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.76,,,324.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.97,,,179.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.05,,,300.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.35,,,317.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,335.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,172.97,,,172.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,275.34,338.88,
HC THYROID STIM IMMUNOGLOB,Px00030016040,CDM,84445,CPT,300,RC,,,,BOTH,,,354,318.6,336.3,,,318.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.12,,,276.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.6,,,294.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.6,,,180.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.6,,,294.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,180.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,318.6,,,318.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.84,,,339.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.19,,,276.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,175.19,,,276.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,325.68,,,325.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,180.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,300.9,,,300.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.3,,,318.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.6,,,336.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,173.46,,,173.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,276.12,339.84,
HC PR ED 67700 DRAINAGE OF EYELID ABSCESS CDM,Px00098110825,CDM,67700,CPT,981,RC,,,,OUTPATIENT,,,1200,1080,672,,,1080,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.83,,,936,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,750,,,998.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,750,,,611.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,750,,,998.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,132.24,,,611.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,138.79,,,1080,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,660,,,1152,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.99,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.99,,,936,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,684,,,1104,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.44,,,611.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,684,,,1020,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,672,,,1080,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,1140,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.99,,,114.99,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,114.99,340.2,
HC ROTH NET FOREIGN BODY 2.5MM 230CM LENGHT 2.5 SHEATH DISP,Sx00000711050,CDM,,,270,RC,,,,BOTH,,,356,320.4,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.68,,,277.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,181.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.76,,,341.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.66,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.18,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,327.52,,,327.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.6,,,302.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,338.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,174.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,277.68,341.76,
HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE,Px00030210868,CDM,86920,CPT,300,RC,,,,BOTH,,,356,320.4,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.68,,,277.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,181.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.76,,,341.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.66,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.18,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,327.52,,,327.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.6,,,302.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,338.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,174.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,277.68,341.76,
HC COMPATIBILITY TEST ANTIGLOB,Px00030011123,CDM,86922,CPT,300,RC,,,,BOTH,,,356,94.5,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.68,,,277.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,181.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.76,,,341.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.66,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.18,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,327.52,,,327.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.6,,,302.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,338.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,174.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,277.68,341.76,
HC SPUTUM SPECIMEN COLLECTION,Px00030011758,CDM,89220,CPT,300,RC,,,,BOTH,,,356,320.4,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.68,,,277.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,181.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,296.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.76,,,341.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.66,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.18,,,277.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,327.52,,,327.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,181.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,302.6,,,302.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.2,,,320.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.4,,,338.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.44,,,174.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,277.68,341.76,
HC PR 46922 EXCISION OF ANAL LESION(S),Px00097510803,CDM,46922,CPT,975,RC,,,,BOTH,,,313,281.7,175.28,,,281.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,189.47,,,244.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.63,,,260.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.63,,,159.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,195.63,,,260.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.96,,,159.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,161.76,,,281.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.15,,,300.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.49,,,244.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.49,,,244.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.41,,,287.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.58,,,159.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.41,,,266.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.28,,,281.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.45,,,297.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.49,,,136.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,136.49,342.45,
HC DRILL BIT 2.7MM,SxAR-8827D-01,CDM,,,270,RC,,,,BOTH,,,357,321.3,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.72,,,342.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.68,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.44,,,328.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.45,,,303.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,174.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,278.46,342.72,
HC DRILL BIT 2.0MM (AO),Sx0AR-8944-22,CDM,,,270,RC,,,,BOTH,,,357,321.3,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.72,,,342.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.68,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.44,,,328.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.45,,,303.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,174.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,278.46,342.72,
HC DRILL BIT 2.5MM,Sx0AR-8943-30,CDM,,,270,RC,,,,BOTH,,,357,321.3,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.72,,,342.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.68,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.44,,,328.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.45,,,303.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,174.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,278.46,342.72,
HC DRILL BIT 2.5MM GRADUATED,Sx0AR-8943-13,CDM,,,270,RC,,,,BOTH,,,357,321.3,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.72,,,342.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.68,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.44,,,328.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.45,,,303.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,174.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,278.46,342.72,
HC DRILL BIT CALIBRATED 2.5MM,Sx0AR-8943-42,CDM,,,270,RC,,,,BOTH,,,357,321.3,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.46,,,278.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,181.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,297.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.72,,,342.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.68,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.44,,,328.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,181.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.45,,,303.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,174.93,,,174.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,278.46,342.72,
HC PR 46221 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS  CDM,Px00097514076,CDM,46221,CPT,975,RC,,,,BOTH,,,698,628.2,390.88,,,628.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,275.61,,,544.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.25,,,550.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.25,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.25,,,550.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,221.79,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,227.97,,,628.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,383.9,,,259.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.86,,,544.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,192.86,,,544.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.86,,,642.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.65,,,355.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.86,,,593.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.88,,,628.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.25,,,663.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,192.86,,,192.86,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,192.86,344.25,
HC TROCAR SLEEVE UNIVERSAL 5x1mm BLUNT TIP,Sx000000CB5LT,CDM,,,270,RC,,,,BOTH,,,358.99,97.31,341.04,,,102.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.01,,,88.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.09,,,94.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.09,,,58.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.09,,,94.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.91,,,58.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.09,,,102.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.63,,,109.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.86,,,88.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.66,,,88.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,330.27,,,104.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.91,,,58.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.14,,,96.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.04,,,102.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.09,,,108.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,175.91,,,175.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.01,344.63,
FLUTICASONE PROPIONATE HFA INHAL AERO 44 MCG/ACT (50/VALVE),Rx00173071820,CDM,,,250,RC,00173-0718-20,NDC,,BOTH,1,EA,358.99,323.09,341.04,,,341.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,280.01,,,280.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,323.09,,,323.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,323.09,,,323.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,323.09,,,323.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.91,,,175.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,323.09,,,323.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,344.63,,,344.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,263.86,,,263.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,177.66,,,177.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,330.27,,,330.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.91,,,175.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,305.14,,,305.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,341.04,,,341.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,323.09,,,323.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,175.91,,,175.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.01,344.63,
HC PR 23620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,Px00097511372,CDM,23620,CPT,975,RC,,,,BOTH,,,622,559.8,348.32,,,559.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,485.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.75,,,517.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.75,,,316.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.75,,,517.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.63,,,316.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,559.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.1,,,597.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,270.98,,,485.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.98,,,485.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,354.54,,,572.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,279.11,,,316.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,354.54,,,528.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.32,,,559.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,345.15,,,590.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,270.98,,,270.98,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,270.98,345.15,
HC L&D TRIAGE NEW PATIENT LVL 1 CDM,Px00076100001,CDM,99202,CPT,761,RC,,,,BOTH,,,360,270,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,312.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,312.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,66.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC CATH TRANTRACHEAL CUSTOM ITEM,Sx0C-DTJV-BTT,CDM,,,270,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC UNI GLENOID PERIPHERAL LOCK SCREW,Sx0AR-9145-24,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC UNI GLENOID PERIPHERAL LOCK SCREW,Sx0AR-9145-30,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC UNI GLENOID PERIPH LOCK SCREW,Sx0AR-9145-36,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC PERIPHERAL SCREW LOCKING 5.5 X 32MM,Sx0AR-6563-32,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC PERIPHERAL SCREW LOCK 5.5X36MM,Sx0AR-9563-36,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,360,324,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.8,,,280.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,183.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,299.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,178.16,,,280.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,331.2,,,331.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,183.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306,,,306,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,324,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,176.4,,,176.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,280.8,345.6,
HC BONE SCREW T10 3.5X14MM,Sx00000614814,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.3 X 14 MM,Sx0053-23214E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.7X22MM,Sx0053-27222E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.7X12MM,Sx0053-27212E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.3 X 28MM,Sx0053-23228E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.3 X 26 MM,Sx0053-23226E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.3 X 22 MM,Sx0053-23222E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC BONE SCREW T7 2.7 X 26MM,Sx0053-27226E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,362.34,326.11,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.63,,,282.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,184.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,301.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.85,,,347.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.32,,,282.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.35,,,333.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,184.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,326.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.11,,,344.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.55,,,177.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.63,347.85,
HC MESH ULTRAPRO LTWT 6X6 PARTIALLY ABSORBABLE,Sx0000000UMM3,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,362.81,333.67,344.67,,,333.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.99,,,289.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.53,,,308.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.53,,,188.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.53,,,308.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.78,,,188.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.53,,,333.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.3,,,355.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.67,,,289.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,179.55,,,289.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.79,,,341.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.78,,,188.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.39,,,315.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.67,,,333.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.53,,,352.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,177.78,,,177.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,282.99,348.3,
HC PR ED 30905 CONTROL OF NOSEBLEED POSTERIOR CDM,Px00098110321,CDM,30905,CPT,981,RC,,,,OUTPATIENT,,,250,225,140,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.02,,,195,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,208.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,127.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.25,,,208.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.82,,,127.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,124.27,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.5,,,240,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.45,,,195,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.45,,,195,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,230,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.52,,,127.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.5,,,212.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140,,,225,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,348.31,,,237.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.45,,,102.45,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,102.45,348.31,
HC PR ED 41250 REPAIR TONGUE LAC <2.6CM FLOOR OF MOUTH AND/OR ANT CDM,Px00098110357,CDM,41250,CPT,981,RC,,,,OUTPATIENT,,,627,564.3,351.12,,,564.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.84,,,489.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,391.88,,,521.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,391.88,,,319.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,391.88,,,521.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,175.2,,,319.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.33,,,564.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.85,,,601.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.35,,,489.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,152.35,,,489.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,357.39,,,576.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.92,,,319.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,357.39,,,532.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,351.12,,,564.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.1,,,595.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.35,,,152.35,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,152.35,350.1,
HC PR ED 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH CDM,Px00098110798,CDM,26770,CPT,981,RC,,,,OUTPATIENT,,,625,562.5,350,,,562.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,338.24,,,487.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.63,,,499.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.63,,,499.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.04,,,562.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,343.75,,,344.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.04,,,487.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.04,,,487.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,356.25,,,575,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.23,,,318.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,356.25,,,531.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350,,,562.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.99,,,593.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.04,,,273.04,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,273.04,350.99,
HC KIT CATH 3 LUMEN 7FR CVC CENTRAL VENOUS,SxAK-24703-AS,CDM,,,270,RC,,,,BOTH,,,366.4,329.76,348.08,,,329.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285.79,,,285.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.76,,,304.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.76,,,186.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.76,,,304.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.54,,,186.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.76,,,329.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.74,,,351.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,269.3,,,285.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,181.33,,,285.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,337.09,,,337.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.54,,,186.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,311.44,,,311.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.08,,,329.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.76,,,348.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,179.54,,,179.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,285.79,351.74,
HC F2 GENE ANALYSIS 20210G >A VARIANT #,Px00031000075,CDM,81240,CPT,300,RC,,,,BOTH,,,370,333,351.5,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.6,,,288.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,188.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,188.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.2,,,355.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.95,,,288.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.11,,,288.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.4,,,340.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,188.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.5,,,314.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.5,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,351.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,181.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,288.6,355.2,
HC US BREAST UNI LIMITED,Px00040210137,CDM,76642,CPT,402,RC,,,,BOTH,,,370,333,351.5,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.6,,,288.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,188.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,307.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,188.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.2,,,355.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.95,,,288.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.11,,,288.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.4,,,340.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,188.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.5,,,314.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.5,,,333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333,,,351.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,181.3,,,181.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,288.6,355.2,
HC PR ED 41800 DRAINAGE OF GUM LESION CDM,Px00098110360,CDM,41800,CPT,981,RC,,,,OUTPATIENT,,,376,338.4,210.56,,,338.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.2,,,293.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235,,,312.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235,,,191.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235,,,312.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.59,,,191.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.09,,,338.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,206.8,,,360.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.77,,,293.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,158.77,,,293.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.32,,,345.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.53,,,191.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.32,,,319.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,210.56,,,338.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,355.49,,,357.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,158.77,,,158.77,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,158.77,355.49,
DAPTOMYCIN FOR IV SOLN 500 MG,Rx70594003402,CDM,J0878,HCPCS,636,RC,70594003402,NDC,,BOTH,500,ME,375.36,337.82,356.59,,,337.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.78,,,292.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,337.82,,,312.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,337.82,,,191.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,337.82,,,312.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.93,,,191.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,337.82,,,337.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.35,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.89,,,292.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,183.93,,,292.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.33,,,345.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.93,,,191.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,319.06,,,319.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.59,,,337.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,337.82,,,356.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,183.93,,,183.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,292.78,360.35,
IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT,Rx00000006728,CDM,,,250,RC,00000-0067-28,NDC,,BOTH,1,EA,377.92,340.13,359.02,,,340.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.78,,,294.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.13,,,314.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.13,,,192.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.13,,,314.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.18,,,192.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.13,,,340.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.8,,,362.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.77,,,294.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.03,,,294.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.69,,,347.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.18,,,192.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.23,,,321.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.02,,,340.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.13,,,359.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.18,,,185.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.78,362.8,
HC PERIPHERAL SCREW LOCK 5.5X16,Sx0AR-9563-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC PERIPHERAL SCREW LOCKING 5.5 X 28MM,Sx0AR-9563-28,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC PERIPHERAL SCREW LOCKING 5.5 X 20MM,Sx0AR-9563-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC PERIPHERAL SCREW LOCKING 5.5 X 24MM,Sx0AR-9563-24,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC PERIPHERAL SCREW LOCK 5.5X32MM,Sx0AR-9563-32,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC XR ENTIRE SPINE MIN 6 VIEWS,Px00032010607,CDM,72084,CPT,320,RC,,,,BOTH,,,378,340.2,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.84,,,294.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,192.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,314.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.88,,,362.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.83,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,187.07,,,294.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.76,,,347.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,192.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,321.3,,,321.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,340.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.2,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,185.22,,,185.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,294.84,362.88,
HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE #,Px00030100838,CDM,83013,CPT,300,RC,,,,BOTH,,,379.91,341.92,360.91,,,341.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.33,,,296.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.92,,,316.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.92,,,193.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.92,,,316.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.16,,,193.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.92,,,341.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.71,,,364.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.23,,,296.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.02,,,296.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.52,,,349.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.16,,,193.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.92,,,322.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.91,,,341.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.92,,,360.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.16,,,186.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,296.33,364.71,
HC SUTURETAPE FIBERLINK 1.7MM WH/BL,Sx0000AR-7538,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,380,342,361,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.4,,,296.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,316.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,193.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,316.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,193.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.3,,,296.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.06,,,296.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.6,,,349.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,193.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323,,,323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,361,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,186.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,296.4,364.8,
HC XR BONE SURVEY COMPLETE,Px00032010341,CDM,77075,CPT,320,RC,,,,BOTH,,,380,342,361,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.4,,,296.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,316.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,193.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,316.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,193.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.3,,,296.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.06,,,296.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.6,,,349.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,193.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323,,,323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361,,,342,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342,,,361,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.2,,,186.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,296.4,364.8,
HC GUIDE WIRE 3.2X230MM UNTHREAD,Sx00000705235,CDM,C1769,HCPCS,278,RC,,,,BOTH,,,381,342.9,361.95,,,342.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.18,,,297.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.9,,,317.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.9,,,194.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.9,,,317.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.69,,,194.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342.9,,,342.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.76,,,365.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.04,,,297.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.56,,,297.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.52,,,350.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.69,,,194.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.85,,,323.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.95,,,342.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.9,,,361.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,186.69,,,186.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,297.18,365.76,
HC BONE SCREW T8 FULL THREAD 2.4MM L16MM,Sx00000656116,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,382.05,343.85,362.95,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298,,,298,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,318.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,194.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,318.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,194.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.77,,,366.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.81,,,298,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.08,,,298,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.49,,,351.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,194.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.74,,,324.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.95,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,362.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,298,366.77,
HC BONE SCREW T8 FULL THREAD 2.4MM L26MM,Sx00000656126,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,382.05,343.85,362.95,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,298,,,298,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,318.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,194.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,318.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,194.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.77,,,366.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,280.81,,,298,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.08,,,298,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.49,,,351.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,194.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.74,,,324.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.95,,,343.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.85,,,362.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,187.2,,,187.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,298,366.77,
HC PR ED 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM,Px00098110281,CDM,12042,CPT,981,RC,,,,OUTPATIENT,,,454,408.6,254.24,,,408.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.42,,,354.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.75,,,377.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.75,,,231.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.75,,,377.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,222.31,,,231.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.28,,,408.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,249.7,,,435.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.31,,,354.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.31,,,354.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.78,,,417.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.11,,,231.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.78,,,385.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.24,,,408.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.1,,,431.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.31,,,193.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,193.31,368.1,
HC TALAR TRIAL SCREW POUCH,Sx00351-90-24,CDM,,,270,RC,,,,BOTH,,,384,345.6,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,195.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.64,,,368.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.04,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.28,,,353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,299.52,368.64,
HC THREADED PIN SIZE 5.1 COLLARLESS 2PK,Sx00521-78-36,CDM,,,270,RC,,,,BOTH,,,384,345.6,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,195.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.64,,,368.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.04,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.28,,,353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,299.52,368.64,
"HC PIN POUCH 3.5""",Sx00351-90-21,CDM,,,270,RC,,,,BOTH,,,384,345.6,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,195.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.64,,,368.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.04,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.28,,,353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,299.52,368.64,
"HC PIN POUCH 2.5""",Sx00351-90-22,CDM,,,270,RC,,,,BOTH,,,384,345.6,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,195.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.64,,,368.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.04,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.28,,,353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,299.52,368.64,
HC DRIVER AO CONNECTION POLY LOCKING SCREW,SxDRVR-AOS-PL,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,384,345.6,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.52,,,299.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,195.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,319.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.64,,,368.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,190.04,,,299.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.28,,,353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,195.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.4,,,326.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.8,,,345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.6,,,364.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.16,,,188.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,299.52,368.64,
HC PR 45335 SIGMOIDOSCOPY W/SUBMUC INJ,Px00097510764,CDM,45335,CPT,975,RC,,,,BOTH,,,720,648,403.2,,,648,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.31,,,561.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,450,,,526.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,450,,,75.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,450,,,526.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,75.46,,,75.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.34,,,648,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,396,,,125.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.62,,,561.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,65.62,,,561.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,662.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,67.59,,,366.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,612,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,648,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,369.01,,,684,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,65.62,,,65.62,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,65.62,369.01,
HC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,Px00047110025,CDM,92587,CPT,571,RC,,,,BOTH,,,385,288.9,365.75,,,288.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.3,,,250.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.5,,,267.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.5,,,163.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.5,,,267.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.65,,,163.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,346.5,,,288.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.6,,,308.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.98,,,250.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.65,,,250.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,354.2,,,295.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.65,,,163.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,327.25,,,272.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.75,,,288.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.5,,,304.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,188.65,,,188.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,300.3,369.6,
HC PR ED 12020 CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM,Px00098110272,CDM,12020,CPT,981,RC,,,,OUTPATIENT,,,442,397.8,247.52,,,397.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,242.91,,,344.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.25,,,367.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.25,,,225.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.25,,,367.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,214.22,,,225.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224.25,,,397.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.1,,,424.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.28,,,344.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,186.28,,,344.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.94,,,406.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.87,,,225.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.94,,,375.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.52,,,397.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370.35,,,419.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.28,,,186.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,186.28,370.35,
HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D,Px00048310003,CDM,93306,CPT,483,RC,,,,BOTH,,,386,347.4,366.7,,,347.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.08,,,301.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.4,,,321.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.4,,,196.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.4,,,321.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.14,,,196.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.4,,,347.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.56,,,370.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,283.71,,,301.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,189.14,,,301.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,355.12,,,355.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.14,,,196.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,328.1,,,328.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.7,,,347.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.4,,,366.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.14,,,189.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,301.08,370.56,
HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM,Px00098110930,CDM,32555,CPT,981,RC,,,,OUTPATIENT,,,256,230.4,143.36,,,230.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.21,,,199.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160,,,213.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160,,,130.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160,,,213.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,119.54,,,130.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,133.29,,,230.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.8,,,245.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,199.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,199.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.92,,,235.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.07,,,130.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.92,,,217.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.36,,,230.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,371.26,,,243.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.95,,,103.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,103.95,371.26,
HC CUTTER LINEAR RELOAD ENDOSCOPIC STANDARD 35MM,Sx000000TR35B,CDM,,,270,RC,,,,BOTH,,,387.5,348.75,368.13,,,348.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.25,,,302.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.75,,,322.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.75,,,197.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.75,,,322.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.88,,,197.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,348.75,,,348.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372,,,372.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.81,,,302.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.77,,,302.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.5,,,356.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.88,,,197.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.38,,,329.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.13,,,348.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.75,,,368.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,189.88,,,189.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,302.25,372,
HC TCC-EZ CASTING SYSTEM 4 IN NO BOOT,Sx000TCC24001,CDM,,,270,RC,,,,BOTH,,,389.23,350.31,369.77,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.6,,,303.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,324.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,198.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,324.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,198.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.66,,,373.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,303.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,192.63,,,303.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,358.09,,,358.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,198.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,330.85,,,330.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.77,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,369.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,190.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,303.6,373.66,
HC TCC-EZ CASTING SYSTEM 3 IN NO BOOT,Sx000TCC23001,CDM,,,270,RC,,,,BOTH,,,389.23,350.31,369.77,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.6,,,303.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,324.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,198.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,324.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,198.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.66,,,373.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.08,,,303.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,192.63,,,303.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,358.09,,,358.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,198.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,330.85,,,330.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.77,,,350.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.31,,,369.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,190.72,,,190.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,303.6,373.66,
HC PR ED 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM,Px00098110288,CDM,12052,CPT,981,RC,,,,OUTPATIENT,,,462,415.8,258.72,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.71,,,360.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,384.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,235.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.75,,,384.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.29,,,235.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.77,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,254.1,,,443.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,360.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.34,,,425.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.67,,,235.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.34,,,392.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,415.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,438.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,196.77,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,196.77,374.85,
HC PR 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM,Px00098310847,CDM,12052,CPT,983,RC,,,,BOTH,,,750,675,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.71,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,624.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,624.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.29,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.77,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.5,,,720,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,690,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.67,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,637.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,712.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.77,,,196.77,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,196.77,374.85,
HC MESH PERFIX SMALL PLUG 1.X1.35 BARD STERILE,Sx00000112750,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,390.6,351.54,371.07,,,351.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.67,,,304.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.54,,,325.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.54,,,199.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.54,,,325.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.39,,,199.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.54,,,351.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.98,,,374.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.09,,,304.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.31,,,304.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,359.35,,,359.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.39,,,199.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,332.01,,,332.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.07,,,351.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.54,,,371.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,191.39,,,191.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,304.67,374.98,
HC PR 26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE,Px00097511362,CDM,26600,CPT,975,RC,,,,BOTH,,,683,614.7,382.48,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,380.32,,,532.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,568.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,568.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.38,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,329.29,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.65,,,655.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,532.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,532.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.31,,,628.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.24,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.31,,,580.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,382.48,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.75,,,648.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,301.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,301.2,375.75,
HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM,Px00098110770,CDM,26600,CPT,981,RC,,,,OUTPATIENT,,,683,614.7,382.48,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,380.32,,,532.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,568.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,568.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.38,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,329.29,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.65,,,655.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,532.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,532.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.31,,,628.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.24,,,348.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.31,,,580.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,382.48,,,614.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.75,,,648.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.2,,,301.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,301.2,375.75,
HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM,Px00098110908,CDM,49083,CPT,981,RC,,,,OUTPATIENT,,,246,221.4,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.52,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,202.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.75,,,202.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.65,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.71,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,135.3,,,236.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,191.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,191.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,226.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.37,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.22,,,209.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.76,,,221.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,376.19,,,233.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,102.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,102.3,376.19,
HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE  CDM,Px00097514078,CDM,49083,CPT,975,RC,,,,BOTH,,,737,663.3,412.72,,,663.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,143.52,,,574.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,460.63,,,549.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,460.63,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,460.63,,,549.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.65,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,129.71,,,663.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,405.35,,,707.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,574.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,574.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420.09,,,678.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.37,,,117.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420.09,,,626.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.72,,,663.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,376.19,,,700.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,102.3,,,102.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,102.3,376.19,
HC SPEECH SOUND LANG COMPREHEN,Px00044010126,CDM,92523,CPT,444,RC,,,,BOTH,,,392,352.8,372.4,,,352.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,326.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,199.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,326.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.08,,,199.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,352.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.32,,,376.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.64,,,360.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.08,,,199.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.2,,,333.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.4,,,352.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,372.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,192.08,,,192.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,305.76,376.32,
HC PR 36590 REMOVAL TUNNELED CV CATH W/PORT OR PUMP,Px00097510989,CDM,36590,CPT,975,RC,,,,BOTH,,,537,483.3,300.72,,,483.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.56,,,418.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.63,,,437.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.63,,,437.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.01,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,227.52,,,483.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,295.35,,,282.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.7,,,418.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,182.7,,,418.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,306.09,,,494.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.18,,,273.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,306.09,,,456.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,300.72,,,483.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.44,,,510.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.7,,,182.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,182.7,378.44,
HC BONE SCREW FULL THRD 2.7MM T10 L10MM,Sx00000657110,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,394.38,354.94,374.66,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.62,,,307.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,328.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,200.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,328.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,200.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.6,,,378.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.87,,,307.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.18,,,307.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,362.83,,,362.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,200.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.22,,,335.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.66,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,374.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,193.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,307.62,378.6,
HC BONE SCREW FULL THRD 2.7MM T10 L12MM,Sx00000657112,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,394.38,354.94,374.66,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.62,,,307.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,328.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,200.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,328.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,200.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.6,,,378.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.87,,,307.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.18,,,307.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,362.83,,,362.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,200.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.22,,,335.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.66,,,354.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.94,,,374.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,193.25,,,193.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,307.62,378.6,
HC 1.5MM DRILL BIT MINI QC 65MM,Sx0000310.141,CDM,,,270,RC,,,,BOTH,,,396,356.4,376.2,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.88,,,308.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,329.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,201.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,329.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,201.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.16,,,380.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.06,,,308.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.98,,,308.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.32,,,364.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,201.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,336.6,,,336.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.2,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,376.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,194.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,308.88,380.16,
HC SCREW BONE 1.7X18MM SELF TAP CROSS PIN,Sx0058-17018E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,396,356.4,376.2,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.88,,,308.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,329.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,201.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,329.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,201.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.16,,,380.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.06,,,308.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,195.98,,,308.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.32,,,364.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,201.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,336.6,,,336.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.2,,,356.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.4,,,376.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,194.04,,,194.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,308.88,380.16,
HC DRILL BIT 2MM GRADUATED,Sx0AR-8943-16,CDM,,,270,RC,,,,BOTH,,,399,359.1,379.05,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,311.22,,,311.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,332.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,203.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,332.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,203.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.04,,,383.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,311.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.47,,,311.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.08,,,367.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,203.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,339.15,,,339.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.05,,,359.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.1,,,379.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,195.51,,,195.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,311.22,383.04,
INSULIN DETEMIR INJ 100 UNIT/ML,Rx00169368712,CDM,J1815,HCPCS,636,RC,169368712,NDC,,BOTH,1,ML,400,360,380,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312,,,312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,332.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,203.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,332.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,203.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384,,,384,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,196,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368,,,368,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,203.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340,,,340,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,380,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,196,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,312,384,
HC LOCKING CLIP ANKLE SZ 4,Sx00350-10-04,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,400,360,380,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312,,,312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,332.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,203.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,332.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,203.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384,,,384,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.96,,,312,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368,,,368,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,203.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340,,,340,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380,,,360,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360,,,380,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196,,,196,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,312,384,
HC SCREW LOCKING 2.3X8MM CROSS PIN SELF-T,Sx0053-23008E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,400.8,360.72,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.62,,,312.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,204.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.77,,,384.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.59,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.36,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368.74,,,368.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.68,,,340.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,380.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,196.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,312.62,384.77,
HC SCREW LOCKING 2.3X9MM CROSS PIN SELF-T,Sx0053-23009E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,400.8,360.72,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.62,,,312.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,204.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.77,,,384.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.59,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.36,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368.74,,,368.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.68,,,340.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,380.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,196.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,312.62,384.77,
HC SCREW LOCKING 2.3X15MM CROSS PIN SELF-T,Sx0053-23015E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,400.8,360.72,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.62,,,312.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,204.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,333.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.77,,,384.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294.59,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,198.36,,,312.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368.74,,,368.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.68,,,340.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.76,,,360.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.72,,,380.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,196.39,,,196.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,312.62,384.77,
HC PR 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM  CDM,Px00097514012,CDM,12032,CPT,975,RC,,,,BOTH,,,439,395.1,245.84,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.81,,,342.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,365.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,365.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.8,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.88,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.45,,,421.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,342.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,342.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250.23,,,403.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.18,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250.23,,,373.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.84,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,417.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,188.52,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,188.52,386.1,
HC PR ED 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM,Px00098110275,CDM,12032,CPT,981,RC,,,,OUTPATIENT,,,439,395.1,245.84,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.81,,,342.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,365.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.38,,,365.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.8,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.88,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.45,,,421.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,342.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,342.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250.23,,,403.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.18,,,223.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250.23,,,373.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.84,,,395.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,417.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.52,,,188.52,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,188.52,386.1,
ZOLEDRONIC ACID IV SOLN 5 MG/100ML,Rx67457061910,CDM,J3489,HCPCS,636,RC,67457061910,NDC,,BOTH,100,ML,402.3,362.07,382.19,,,362.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,313.79,,,313.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.07,,,334.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.07,,,205.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.07,,,334.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.13,,,205.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,362.07,,,362.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.21,,,386.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,295.69,,,313.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,197.13,,,313.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,370.12,,,370.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.13,,,205.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.96,,,341.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.19,,,362.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.07,,,382.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.13,,,197.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,313.79,386.21,
HC PR 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION,Px00097510673,CDM,27530,CPT,975,RC,,,,BOTH,,,690,621,386.4,,,621,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,383.81,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.25,,,574.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.25,,,351.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.25,,,574.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.53,,,351.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.04,,,621,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,379.5,,,662.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.33,,,538.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,301.33,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.3,,,634.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.37,,,351.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.3,,,586.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,621,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,387,,,655.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.33,,,301.33,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,301.33,387,
HC US OB TRANSVAGINAL,Px00040210024,CDM,76817,CPT,402,RC,,,,BOTH,,,404,363.6,383.8,,,363.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.12,,,315.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.6,,,336.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.6,,,205.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.6,,,336.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.96,,,205.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,363.6,,,363.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387.84,,,387.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,315.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,199.94,,,315.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.68,,,371.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.96,,,205.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,343.4,,,343.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.8,,,363.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.6,,,383.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,197.96,,,197.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,315.12,387.84,
HC ED FAC E&M VISIT LEVEL 2 CDM,Px00045010207,CDM,99282,CPT,450,RC,,,,OUTPATIENT,,,405,288,384.75,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.9,,,274.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,293.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,179.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,293.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,337.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.68,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.43,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,323.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,344.25,,,299.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.75,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,334.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,198.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,315.9,388.8,
HC ED TIXAGEVIMAB AND CILGAVIMAB (EVUSHELD) INJECTION M0220,Px00045000035,CDM,M0220,CPT,450,RC,,,,OUTPATIENT,,,405,288,384.75,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.9,,,274.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,293.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,179.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,293.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,337.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.68,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.43,,,274.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,323.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,179.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,344.25,,,299.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.75,,,316.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,334.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,198.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,315.9,388.8,
HC LAG SCREW 3.2 X 20MM,Sx00LAG3.2-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,405,364.5,384.75,,,364.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.9,,,315.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,337.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,206.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,337.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,206.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,364.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,297.68,,,315.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.43,,,315.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,206.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,344.25,,,344.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.75,,,364.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.5,,,384.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,198.45,,,198.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,315.9,388.8,
HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR,Px00031010799,CDM,81596,CPT,300,RC,,,,BOTH,,,407.15,366.44,386.79,,,366.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.58,,,317.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.44,,,338.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.44,,,207.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.44,,,338.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,207.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,366.44,,,366.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390.86,,,390.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.26,,,317.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.5,,,317.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374.58,,,374.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,207.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,346.08,,,346.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.79,,,366.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.44,,,386.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.5,,,199.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,317.58,390.86,
HC WASHER FOR 6.5/8MM SCREWS ASNIS III SS,Sx00000390016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,408,367.2,387.6,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.24,,,318.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,339.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,207.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,339.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.92,,,207.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.68,,,391.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,299.88,,,318.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,201.92,,,318.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,375.36,,,375.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.92,,,207.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,346.8,,,346.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,199.92,,,199.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,318.24,391.68,
HC PR 57520 CONIZATION OF CERVIX COLD KNIFE OR LASER,Px00097511185,CDM,57520,CPT,975,RC,,,,BOTH,,,850,765,476,,,765,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.48,,,663,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.25,,,707.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.25,,,433.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.25,,,707.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336.66,,,433.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.78,,,765,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.5,,,816,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.75,,,663,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,292.75,,,663,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,782,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.53,,,433.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,722.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,476,,,765,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,391.96,,,807.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.75,,,292.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,292.75,391.96,
LEUPROLIDE ACETATE FOR INJ KIT 7.5 MG,Rx00074364203,CDM,J9217,HCPCS,636,RC,74364203,NDC,,BOTH,7.5,ML,409.63,895.02,389.15,,,368.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.51,,,319.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.67,,,341.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.67,,,208.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.67,,,341.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.72,,,208.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,368.67,,,368.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.24,,,393.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.08,,,319.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,200.72,,,319.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,376.86,,,376.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.72,,,208.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,348.19,,,348.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.15,,,368.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.67,,,389.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,200.72,,,200.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,319.51,393.24,
HC SURGICEL HEMOSTATIC 4X8 0,Sx00000001952,CDM,,,270,RC,,,,BOTH,,,410.21,369.19,389.7,,,369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.96,,,319.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.19,,,341.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.19,,,209.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.19,,,341.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201,,,209.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,369.19,,,369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.8,,,393.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.5,,,319.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.01,,,319.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,377.39,,,377.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201,,,209.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,348.68,,,348.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.7,,,369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.19,,,389.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201,,,201,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,319.96,393.8,
HC DRILL BIT 5.0MM,Sx000905-0016,CDM,,,270,RC,,,,BOTH,,,412,370.8,391.4,,,370.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.36,,,321.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.8,,,342.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.8,,,209.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.8,,,342.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.88,,,209.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,370.8,,,370.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.52,,,395.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.82,,,321.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,203.9,,,321.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.04,,,379.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.88,,,209.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.2,,,350.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.4,,,370.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.8,,,391.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,201.88,,,201.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,321.36,395.52,
HC BACKPLATE PRESSURE TRANSD HOLDER,Sx0000TCLIP05,CDM,,,270,RC,,,,BOTH,,,412.72,338.26,392.08,,,371.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.92,,,321.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.45,,,343.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.45,,,210.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.45,,,343.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.23,,,210.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.45,,,371.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.21,,,396.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.35,,,321.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.26,,,321.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.7,,,379.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.23,,,210.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.81,,,350.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,392.08,,,371.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.45,,,392.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.23,,,202.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,321.92,396.21,
HC PR ED 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM,Px00098110276,CDM,12034,CPT,981,RC,,,,OUTPATIENT,,,478,430.2,267.68,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.07,,,372.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,397.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,397.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.38,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.11,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,262.9,,,458.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.07,,,372.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,202.07,,,372.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.46,,,439.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.13,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.46,,,406.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.68,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,396.89,,,454.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,202.07,,,202.07,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,202.07,396.89,
HC TCC-EZ CASTING SYSTEM,Px00012051WNH,CDM,,,270,RC,,,,BOTH,,,414,372.6,393.3,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.92,,,322.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,344.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,210.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,344.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,210.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.29,,,322.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.89,,,322.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,380.88,,,380.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,210.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.9,,,351.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.3,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,393.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,202.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,322.92,397.44,
HC FACTOR V LEIDEN GENE ANALYSIS,Px00030010272,CDM,81241,CPT,300,RC,,,,BOTH,,,414,372.6,393.3,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.92,,,322.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,344.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,210.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,344.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,210.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,304.29,,,322.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,204.89,,,322.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,380.88,,,380.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,210.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.9,,,351.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.3,,,372.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.6,,,393.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,202.86,,,202.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,322.92,397.44,
HC PR 43235 EGD DIAGNOSTIC BRUSH WASH,Px00097510294,CDM,43235,CPT,975,RC,,,,BOTH,,,285,256.5,159.6,,,256.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.96,,,222.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.13,,,235.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.13,,,137.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,178.13,,,235.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.26,,,137.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,149.35,,,256.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.75,,,180.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.49,,,222.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.49,,,222.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.45,,,262.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.04,,,145.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.45,,,242.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.6,,,256.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,270.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.49,,,118.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,118.49,397.8,
BECLOMETHASONE DIPROP HFA BREATH ACT INH AER 40 MCG/ACT,Rx59310030240,CDM,,,250,RC,59310-0302-40,NDC,,BOTH,0.04,ME,415.17,366.59,394.41,,,373.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.83,,,323.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.65,,,345.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.65,,,211.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.65,,,345.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.43,,,211.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,373.65,,,373.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.56,,,398.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.15,,,323.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.47,,,323.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,381.96,,,382.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.43,,,211.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,352.89,,,352.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.41,,,373.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.65,,,394.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.43,,,203.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,323.83,398.56,
HC MAMMO DIAG BIL W CAD,Px00040110004,CDM,77066,CPT,401,RC,,,,BOTH,,,416,374.4,395.2,,,296.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.48,,,324.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,275.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,211.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,275.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.84,,,211.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.36,,,399.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,324.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.88,,,324.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.72,,,382.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.84,,,211.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,353.6,,,353.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.2,,,296.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,395.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,203.84,,,203.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,324.48,399.36,
HC PR 11406 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM  CDM,Px00097514003,CDM,11406,CPT,975,RC,,,,BOTH,,,582,523.8,325.92,,,523.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,316.39,,,453.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,363.75,,,468.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,363.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,363.75,,,468.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,282.12,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.92,,,523.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,320.1,,,331.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.32,,,453.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,245.32,,,453.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.74,,,535.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.68,,,296.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.74,,,494.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,325.92,,,523.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.5,,,552.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.32,,,245.32,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,245.32,400.5,
HC PR ED 23650 TREAT SHOULDER DISLOCATION W/MANIP CDM,Px00098110570,CDM,23650,CPT,981,RC,,,,OUTPATIENT,,,707,636.3,395.92,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,382.71,,,551.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,588.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,360.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.88,,,588.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,357.22,,,360.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.22,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.85,,,678.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,551.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,551.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.99,,,650.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319.95,,,360.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.99,,,600.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.92,,,636.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.95,,,671.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,310.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,310.63,400.95,
SODIUM HYALURONATE INTRA-ARTICULAR SOLN PREF SYR 20 MG/2ML,Rx89122072420,CDM,J7321,HCPCS,636,RC,89122072420,NDC,,BOTH,2,ML,418.5,376.65,397.58,,,376.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.43,,,326.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.65,,,348.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.65,,,213.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.65,,,348.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.07,,,213.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,376.65,,,376.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.76,,,401.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.6,,,326.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.07,,,326.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.02,,,385.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.07,,,213.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,355.73,,,355.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.58,,,376.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.65,,,397.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.07,,,205.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,326.43,401.76,
NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML),Rx63323041536,CDM,J2710,HCPCS,636,RC,63323041536,NDC,,BOTH,10,ML,418.7,376.83,397.77,,,376.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.59,,,326.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.83,,,348.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.83,,,213.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.83,,,348.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,213.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,376.83,,,376.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.95,,,401.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.74,,,326.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,326.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,385.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,213.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,355.9,,,355.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.77,,,376.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.83,,,397.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.16,,,205.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,326.59,401.95,
HC DRILL TWIST 2.0X105MM AO,Sx00060-20385,CDM,,,270,RC,,,,BOTH,,,419.52,377.57,398.54,,,377.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.23,,,327.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,377.57,,,349.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,377.57,,,213.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,377.57,,,349.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.56,,,213.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,377.57,,,377.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.74,,,402.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.35,,,327.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.62,,,327.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.96,,,385.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.56,,,213.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.59,,,356.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.54,,,377.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,377.57,,,398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.56,,,205.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.23,402.74,
HC ED LONG ARM SPLINT APPLICATION CDM,Px00045013106,CDM,29105,CPT,450,RC,,,,OUTPATIENT,,,420,298.8,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,284.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,315.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,315.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,335.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,310.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC ED APPLICATION LONG LEG SPLINT CDM,Px00045013127,CDM,29505,CPT,450,RC,,,,OUTPATIENT,,,420,298.8,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,284.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,186,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,350.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,335.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,310.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC ED SHORT LEG SPLINT APPLICATION CDM,Px00045013130,CDM,29515,CPT,450,RC,,,,OUTPATIENT,,,420,298.8,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,284.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,186,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,350.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,335.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,310.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC ED STRAPPING OF ANKLE AND/OR FT CDM,Px00045013137,CDM,29540,CPT,450,RC,,,,OUTPATIENT,,,420,298.8,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,284.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,186,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,303.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,350.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,284.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,335.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,186,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,310.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,328.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC L&D TRIAGE ESTAB PATIENT LVL 2 CDM,Px00076110526,CDM,99212,CPT,761,RC,,,,BOTH,,,420,315,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,354.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,354.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,33.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC 1.8MM DRILL FOR FIBERTAK,SxAR-3600ND-2,CDM,,,270,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC RETRIEVER FOOD BOLUS ROTH NET PLATINUM 2.5MM,Sx0BX00711155,CDM,,,270,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
"HC #2 FIBERSNARE, #2 FIBERWIRE, 26""",Sx00AR-7209SN,CDM,,,270,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC SPADE TIP DRILL FOR 3.9MM SWIVELOCK,Sx000AR-2326D,CDM,,,270,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC SCREW TI 2.4X18MM VAL,SxAR-8724V-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC SCREW TI 2.4X20MM VAL,SxAR-8724V-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC SCREW TI 2.4X22MM VAL,SxAR-8724V-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,420,378,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,214.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,349.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.2,,,403.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,207.86,,,327.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.4,,,386.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,214.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357,,,357,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399,,,378,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378,,,399,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,205.8,,,205.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,327.6,403.2,
HC DEBRIDEMENT OPEN WOUND 20 SQ CM/<,Px00076110466,CDM,97597,CPT,761,RC,,,,BOTH,,,421,378.9,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.38,,,328.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,214.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.16,,,404.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.44,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.32,,,387.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357.85,,,357.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,399.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,206.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,328.38,404.16,
HC NEGATIVE PRESSURE WOUND THERAPY DME,Px00076110469,CDM,97605,CPT,761,RC,,,,BOTH,,,421,378.9,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.38,,,328.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,214.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.16,,,404.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.44,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.32,,,387.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357.85,,,357.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,399.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,206.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,328.38,404.16,
HC US ABDOMEN LIMITED,Px00040210104,CDM,76705,CPT,402,RC,,,,BOTH,,,421,378.9,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.38,,,328.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,214.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,350.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.16,,,404.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.44,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,208.35,,,328.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.32,,,387.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,214.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357.85,,,357.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.95,,,378.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.9,,,399.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.29,,,206.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,328.38,404.16,
HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE^,Px00076110460,CDM,17250,CPT,761,RC,,,,BOTH,,,422,379.8,400.9,,,379.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.16,,,329.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.8,,,351.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.8,,,215.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.8,,,351.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.78,,,215.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.8,,,379.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.12,,,405.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,329.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,206.78,,,329.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.24,,,388.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.78,,,215.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,358.7,,,358.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,400.9,,,379.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.8,,,400.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,206.78,,,206.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,329.16,405.12,
HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM,Px00098110402,CDM,27786,CPT,981,RC,,,,OUTPATIENT,,,1324,1191.6,741.44,,,1191.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,381.61,,,1032.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,827.5,,,1102.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,827.5,,,674.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,827.5,,,1102.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.96,,,674.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,339.29,,,1191.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,728.2,,,1271.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.49,,,1032.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.49,,,1032.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,754.68,,,1218.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,305.38,,,674.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,754.68,,,1125.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,741.44,,,1191.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,405.45,,,1257.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.49,,,296.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,296.49,405.45,
HC PR 57461 CONZ OF CERVIX W/SCOPE LEEP,Px00097511184,CDM,57461,CPT,975,RC,,,,BOTH,,,874,786.6,489.44,,,786.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,212.96,,,681.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,546.25,,,667.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,546.25,,,204.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,546.25,,,667.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.45,,,204.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,219.88,,,786.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,480.7,,,260.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.91,,,681.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.91,,,681.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.18,,,804.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.22,,,445.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.18,,,742.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.44,,,786.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,406.35,,,830.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.91,,,176.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,176.91,406.35,
HC PR ED 25650 TREAT ULNAR STYLOID FRACTURE CDM,Px00098110754,CDM,25650,CPT,981,RC,,,,OUTPATIENT,,,731,657.9,409.36,,,657.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,403.68,,,570.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,456.88,,,608.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,456.88,,,372.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,456.88,,,608.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,365.36,,,372.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,355.86,,,657.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.05,,,701.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,570.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,570.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.67,,,672.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.23,,,372.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.67,,,621.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,409.36,,,657.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,694.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.7,,,317.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,317.7,409.5,
HC BASKET RETRIEVAL ROTABLE 2.5MM 3.5X6,Sx00000711141,CDM,,,270,RC,,,,BOTH,,,428,385.2,406.6,,,385.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333.84,,,333.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,356.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,218.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,356.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.72,,,218.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,385.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.88,,,410.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.58,,,333.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.82,,,333.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.76,,,393.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.72,,,218.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,363.8,,,363.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,406.6,,,385.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.2,,,406.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.72,,,209.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,333.84,410.88,
ALTEPLASE FOR INJ 2 MG,Rx50242004164,CDM,J2997,HCPCS,636,RC,50242004164,NDC,,BOTH,2,ME,428.34,367.43,406.92,,,385.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.11,,,334.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.51,,,356.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.51,,,218.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.51,,,356.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.89,,,218.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.51,,,385.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.21,,,411.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.83,,,334.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,209.89,,,334.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,394.07,,,394.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.89,,,218.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.09,,,364.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,406.92,,,385.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.51,,,407.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,209.89,,,209.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,334.11,411.21,
HC PR ED 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP CDM,Px00098110773,CDM,26605,CPT,981,RC,,,,OUTPATIENT,,,710,639,397.6,,,639,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.16,,,553.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,443.75,,,591.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,443.75,,,361.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,443.75,,,591.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,355.03,,,361.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,347.94,,,639,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,390.5,,,681.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.72,,,553.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.72,,,553.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,404.7,,,653.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.98,,,361.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,404.7,,,603.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.6,,,639,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.3,,,674.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.72,,,308.72,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,308.72,411.3,
HC PR 59812 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,Px00097511317,CDM,59812,CPT,975,RC,,,,BOTH,,,741,666.9,414.96,,,666.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.45,,,577.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.13,,,616.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.13,,,377.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.13,,,616.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,343.68,,,377.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,349.54,,,666.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,407.55,,,711.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.85,,,577.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.85,,,577.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,422.37,,,681.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.82,,,377.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,422.37,,,629.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.96,,,666.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.75,,,703.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.85,,,298.85,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,298.85,411.75,
HC PR 25111 REMOVE WRST TEND LESION,Px00097510910,CDM,25111,CPT,975,RC,,,,BOTH,,,770,693,431.2,,,693,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,425.71,,,600.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.25,,,638.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.25,,,382.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.25,,,638.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,382.9,,,382.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,381.98,,,693,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,423.5,,,429.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,600.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,600.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,708.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.95,,,392.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,654.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.2,,,693,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.75,,,731.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,317.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,317.63,411.75,
HC PR ED 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH CDM,Px00098110781,CDM,26700,CPT,981,RC,,,,OUTPATIENT,,,1204,1083.6,674.24,,,1083.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,403.13,,,939.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.5,,,1002.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.5,,,613.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.5,,,1002.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,372.37,,,613.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,359.54,,,1083.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,662.2,,,1155.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,323.8,,,939.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.8,,,939.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,686.28,,,1107.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,333.51,,,613.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,686.28,,,1023.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,674.24,,,1083.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.75,,,1143.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,323.8,,,323.8,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,323.8,411.75,
HC TIGHTROPE ABS BUTTON 8X12MM,Sx00AR-1588TB,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,429,386.1,407.55,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.62,,,334.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,357.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,218.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,357.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.21,,,218.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.84,,,411.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,315.32,,,334.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.31,,,334.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,394.68,,,394.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.21,,,218.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.65,,,364.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.55,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,407.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.21,,,210.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,334.62,411.84,
HC PR ED 41252 REPAIR OF LACER OF TONGUE FLOOR OF MOUTH >2.6 C CDM,Px00098110359,CDM,41252,CPT,981,RC,,,,OUTPATIENT,,,861,774.9,482.16,,,774.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.15,,,671.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,538.13,,,716.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,538.13,,,438.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,538.13,,,716.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.68,,,438.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.8,,,774.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,473.55,,,826.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.81,,,671.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,205.81,,,671.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.77,,,792.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.98,,,438.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.77,,,731.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,482.16,,,774.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.2,,,817.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,205.81,,,205.81,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,205.81,412.2,
HC BILL SURG LEVEL 5,Px00031010236,CDM,88307,CPT,300,RC,,,,BOTH,,,430,387,408.5,,,387,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.4,,,335.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387,,,357.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387,,,219.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387,,,357.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.7,,,219.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387,,,387,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,412.8,,,412.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.05,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,212.81,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,395.6,,,395.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.7,,,219.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,365.5,,,365.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,408.5,,,387,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387,,,408.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,210.7,,,210.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,335.4,412.8,
HC SAW BLADE OSCILLATING 9MM S TYPE,Sx00000OSB-9S,CDM,,,270,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC QUANTIFERON TB GOLD,Px00030210934,CDM,86480,CPT,300,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,Px00030200149,CDM,86480,CPT,300,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,Px00030200540,CDM,86480,CPT,300,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,Px00030200541,CDM,86480,CPT,300,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,Px00030200542,CDM,86480,CPT,300,RC,,,,BOTH,,,432,388.8,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.96,,,336.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,220.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,359.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.72,,,414.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,317.52,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.8,,,336.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.44,,,397.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,220.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,367.2,,,367.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,388.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.8,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,211.68,,,211.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.96,414.72,
HC PR 28011 INCISION OF TOE TENDONS,Px00097511257,CDM,28011,CPT,975,RC,,,,BOTH,,,750,675,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,357.43,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,624.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,624.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,323.24,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,341.16,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.5,,,720,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.08,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.08,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,690,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.51,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,637.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.7,,,712.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.08,,,281.08,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,281.08,416.7,
HC DEBRIDE/DRESS SMALL BURN LT 5 TBSA,Px00076110177,CDM,16020,CPT,761,RC,,,,BOTH,,,435,391.5,413.25,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.3,,,339.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,362.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,221.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,362.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,221.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,417.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.73,,,339.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,339.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,400.2,,,400.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,221.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,369.75,,,369.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,413.25,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,413.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,213.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,339.3,417.6,
HC TRANSTIBIAL ACL DISPOSABLE KIT DISPOSABLE TRANSTIB W/O SAWBLD,Sx000AR-1898S,CDM,,,270,RC,,,,BOTH,,,435,391.5,413.25,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.3,,,339.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,362.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,221.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,362.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,221.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,417.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.73,,,339.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.28,,,339.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,400.2,,,400.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,221.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,369.75,,,369.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,413.25,,,391.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.5,,,413.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,213.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,339.3,417.6,
HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM,Px00098110742,CDM,25600,CPT,981,RC,,,,OUTPATIENT,,,1235,1111.5,691.6,,,1111.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,430.73,,,963.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,771.88,,,1028.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,771.88,,,629.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,771.88,,,1028.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,391.46,,,629.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,369.72,,,1111.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,679.25,,,1185.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.4,,,963.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.4,,,963.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,703.95,,,1136.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.61,,,629.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,703.95,,,1049.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,691.6,,,1111.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,419.4,,,1173.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.4,,,340.4,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,340.4,419.4,
HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 312 UNIT/ML,Rx59730420201,CDM,90371,CPT,636,RC,59730420201,NDC,,BOTH,1,ML,437.99,394.19,416.09,,,416.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,341.63,,,341.63,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,394.19,,,394.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,394.19,,,394.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,394.19,,,394.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.62,,,214.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,394.19,,,394.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,420.47,,,420.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,321.92,,,321.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,214.62,,,214.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,402.95,,,402.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.62,,,214.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,372.29,,,372.29,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,416.09,,,416.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,394.19,,,394.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,214.62,,,214.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,341.63,420.47,
LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG,Rx63323064994,CDM,,,250,RC,63323-0649-94,NDC,,BOTH,1,EA,439.83,395.85,417.84,,,395.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.07,,,343.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.85,,,366.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.85,,,224.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.85,,,366.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.52,,,224.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,395.85,,,395.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.24,,,422.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.28,,,343.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.67,,,343.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.64,,,404.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.52,,,224.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,373.86,,,373.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.84,,,395.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.85,,,417.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.52,,,215.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,343.07,422.24,
HC ECLIPSE CAGE SCREW SIZER,SxAR-9401-08S,CDM,,,270,RC,,,,BOTH,,,440,396,418,,,396,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.2,,,343.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396,,,366.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396,,,224.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396,,,366.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.6,,,224.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,396,,,396,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.4,,,422.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,343.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,217.76,,,343.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.8,,,404.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.6,,,224.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374,,,374,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418,,,396,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396,,,418,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.6,,,215.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,343.2,422.4,
HC MESH PROLENE 12X12 IN POLPROPYLENE PML,Sx000000ETPML,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,440.66,405.26,418.63,,,405.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.71,,,351.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.59,,,374.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.59,,,229.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.59,,,374.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.92,,,229.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,396.59,,,405.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.03,,,432.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.89,,,351.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.08,,,351.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405.41,,,414.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.92,,,229.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374.56,,,382.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.63,,,405.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.59,,,427.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,215.92,,,215.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,343.71,423.03,
HC DRILL BIT 2.0MM FOR 2.7MM DISTAL LOCKING SCREWS,Sx0000AR-2669,CDM,,,270,RC,,,,BOTH,,,441,396.9,418.95,,,396.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,343.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,367.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,224.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,367.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.09,,,224.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,396.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.36,,,423.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324.14,,,343.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.25,,,343.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,405.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.09,,,224.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,374.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,396.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,418.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,216.09,,,216.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,343.98,423.36,
HC LINEAR CUTTER TCT75 RELOADABLE TITANIUM THICK TISSUE 77MM,Sx000000TCT75,CDM,,,270,RC,,,,BOTH,,,444.33,406.32,422.11,,,406.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.58,,,352.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.9,,,375.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.9,,,230.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.9,,,375.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.72,,,230.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,399.9,,,406.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.56,,,433.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,326.58,,,352.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.9,,,352.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408.78,,,415.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.72,,,230.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,377.68,,,383.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.11,,,406.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.9,,,428.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,217.72,,,217.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,346.58,426.56,
HC METER DOSE INHALER,Px00041210004,CDM,94640,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC NEBULIZER SMALL VOLUME,Px00041210006,CDM,94640,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC INTRAPULMONARY PERCUSSION VENTILATION THERAPY,Px00041010340,CDM,94640,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC SPUTUM INDUCTION,Px00041010353,CDM,94640,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,373.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC NONINVASIVE VENTILATION/CPAP FIRST DAY CDM,Px00041010325,CDM,94660,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,227.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,429.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM,Px00041010328,CDM,94660,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,227.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,429.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
HC HOME CPAP MANAGEMENT DAILY,Px00041010366,CDM,94660,CPT,410,RC,,,,BOTH,,,447,402.3,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.66,,,348.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,227.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,372.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.12,,,429.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.55,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,221.22,,,348.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.24,,,411.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,227.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.95,,,379.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.65,,,402.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.3,,,424.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.03,,,219.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.66,429.12,
ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML,Rx58160082311,CDM,90750,CPT,636,RC,58160082311,NDC,,BOTH,0.5,ML,447.03,400.84,424.68,,,432.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.68,,,374.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.33,,,399.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.33,,,244.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.33,,,399.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.04,,,244.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.33,,,432.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.15,,,461.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,328.57,,,374.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.04,,,374.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.27,,,441.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.04,,,244.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.98,,,408.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.68,,,432.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.33,,,456.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.04,,,219.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,348.68,429.15,
HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML,Rx58160082643,CDM,90632,CPT,636,RC,58160082643,NDC,,BOTH,5,ML,448.09,403.28,425.69,,,403.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.51,,,349.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.28,,,374.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.28,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.28,,,374.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.56,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,403.28,,,403.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,430.17,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,329.35,,,349.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,219.56,,,349.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,412.24,,,412.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.56,,,228.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,380.88,,,380.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,425.69,,,403.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.28,,,425.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,219.56,,,219.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,349.51,430.17,
HC PR ED 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/MANI CDM,Px00098110786,CDM,26725,CPT,981,RC,,,,OUTPATIENT,,,728,655.2,407.68,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,399.37,,,567.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,605.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,370.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455,,,605.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.38,,,370.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,359.65,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.4,,,698.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.11,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,315.11,,,567.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.96,,,669.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.56,,,370.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.96,,,618.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,407.68,,,655.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,430.65,,,691.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.11,,,315.11,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,315.11,430.65,
HC CATHETER ASPIRATION NASOTRACHEAL SPX,Px00041010360,CDM,31720,CPT,361,RC,,,,BOTH,,,449,404.1,426.55,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.22,,,350.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,373.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,228.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,373.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,228.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.04,,,431.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.02,,,350.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.21,,,350.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,413.08,,,413.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,228.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,381.65,,,381.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.55,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,426.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,220.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,350.22,431.04,
HC NEBULIZER PENTAMIDINE,Px00041210007,CDM,94642,CPT,410,RC,,,,BOTH,,,449,404.1,426.55,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.22,,,350.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,373.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,228.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,373.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,228.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.04,,,431.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.02,,,350.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.21,,,350.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,413.08,,,413.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,228.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,381.65,,,381.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.55,,,404.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.1,,,426.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.01,,,220.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,350.22,431.04,
HC SCREW LO-PRO LOCK TI 3.5X14MM,SxAR-8935L-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,450,405,427.5,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351,,,351,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,374.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,229.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,374.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,229.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.75,,,351,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.71,,,351,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,414,,,414,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,229.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.5,,,382.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,427.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,351,432,
HC SCREW LO-PRO LOCK TI 3.5X16MM,SxAR-8935L-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,450,405,427.5,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351,,,351,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,374.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,229.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,374.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,229.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.75,,,351,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.71,,,351,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,414,,,414,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,229.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.5,,,382.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,405,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405,,,427.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.5,,,220.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,351,432,
HC CLIP FILSHIE TUBAL 0,Sx000AVM-851J,CDM,,,270,RC,,,,BOTH,,,450.51,405.46,427.98,,,405.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,351.4,,,351.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.46,,,375,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.46,,,229.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.46,,,375,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.75,,,229.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405.46,,,405.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.49,,,432.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,331.12,,,351.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,222.96,,,351.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,414.47,,,414.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.75,,,229.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.93,,,382.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.98,,,405.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.46,,,427.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,220.75,,,220.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,351.4,432.49,
HC PR 25000 INCISION OF TENDON SHEATH,Px00096910705,CDM,25000,CPT,983,RC,,,,BOTH,,,818,736.2,458.08,,,736.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,453.54,,,638.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.25,,,678.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.25,,,407.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.25,,,678.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,407.25,,,407.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.74,,,736.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,449.9,,,450.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.25,,,638.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.25,,,638.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,466.26,,,752.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,364.75,,,416.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,466.26,,,695.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,458.08,,,736.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,432.9,,,777.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.25,,,426.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,426.25,432.9,
HC PR ED 26670 CLTX CARPO/METACARPL DISLC NOT THMB MANJ EA W/O ANES CDM,Px00098110779,CDM,26670,CPT,981,RC,,,,OUTPATIENT,,,749,674.1,419.44,,,674.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,406.97,,,584.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.13,,,623.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.13,,,381.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.13,,,623.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.43,,,381.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,366.6,,,674.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.95,,,719.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,325.59,,,584.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,325.59,,,584.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.93,,,689.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.36,,,381.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.93,,,636.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,419.44,,,674.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.35,,,711.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,325.59,,,325.59,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,325.59,433.35,
HC PR ED 23545 TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM,Px00098110559,CDM,23545,CPT,981,RC,,,,OUTPATIENT,,,753,677.7,421.68,,,677.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,410.49,,,587.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.63,,,626.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.63,,,383.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.63,,,626.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,385.6,,,383.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.7,,,677.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.15,,,722.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,587.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,587.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,429.21,,,692.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,345.36,,,383.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,429.21,,,640.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.68,,,677.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.15,,,715.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,335.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,335.3,435.15,
HC ASSAY TEST FOR BLOOD FECAL,Px00030112278,CDM,82274,CPT,300,RC,,,,BOTH,,,455,409.5,432.25,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,354.9,,,354.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,378.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,231.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,378.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.95,,,231.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.8,,,436.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.43,,,354.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.18,,,354.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,418.6,,,418.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.95,,,231.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.75,,,386.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.25,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,432.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,222.95,,,222.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,354.9,436.8,
HC PR 19101 BIOPSY OF BREAST OPEN,Px00097510356,CDM,19101,CPT,975,RC,,,,BOTH,,,1658,1492.2,928.48,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,285.79,,,1293.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,1380.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,844.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,1380.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.67,,,844.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,262.81,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,911.9,,,1591.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.84,,,1293.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.84,,,1293.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.06,,,1525.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.41,,,844.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.06,,,1409.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,928.48,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,436.95,,,1575.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.84,,,218.84,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,218.84,436.95,
BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT,Rx00186037020,CDM,,,250,RC,00186-0370-20,NDC,,BOTH,1,EA,455.25,676.58,432.49,,,432.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,355.1,,,355.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,409.73,,,409.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,409.73,,,409.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,409.73,,,409.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,223.07,,,223.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.73,,,409.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,437.04,,,437.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,334.61,,,334.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,225.3,,,225.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.83,,,418.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,223.07,,,223.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.96,,,386.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,432.49,,,432.49,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,409.73,,,409.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,223.07,,,223.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.1,437.04,
HC SCREW NON LOCK 3.5 X 10MM IMPL,Sx000PLSS3512,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW NON LOCK 3.5 X 16MM IMPL,Sx000PLSS3516,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW NON LOCK 3.5 X 20MM IMPL,Sx000PLSS3520,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW NON LOCK 3.5 X 26MM IMPL,Sx000PLSS3526,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW STANDARD 3X10MM ANCHOR,Sx000PLSS3010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW STANDARD 3X12MM ANCHOR,Sx000PLSS3012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW STANDARD 3X24MM ANCHOR,Sx000PLSS3024,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW NON LOCK 3 X 16MM IMPL,Sx000PLSS3016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC SCREW NON LOCK 3 X 26MM IMPL,Sx000PLSS3026,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,456,410.4,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.68,,,355.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,232.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,379.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.76,,,437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,335.16,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.67,,,355.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.52,,,419.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,232.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,387.6,,,387.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.2,,,410.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.4,,,433.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,223.44,,,223.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,355.68,437.76,
HC RELOAD LINEAR STAPLE 60MM BLUE,Sx00000GST60B,CDM,,,270,RC,,,,BOTH,,,457.61,422.38,434.73,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.94,,,366.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,390.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,239.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,390.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,239.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,439.31,,,450.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.34,,,366.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.47,,,366.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421,,,431.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,239.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.97,,,398.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.73,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,445.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,224.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,356.94,439.31,
HC RELOAD STAPLER 12MM ENDOPATH GST60W,Sx00000GST60W,CDM,,,270,RC,,,,BOTH,,,457.61,422.38,434.73,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.94,,,366.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,390.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,239.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,390.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,239.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,439.31,,,450.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.34,,,366.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.47,,,366.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421,,,431.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,239.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,388.97,,,398.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.73,,,422.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.85,,,445.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,224.23,,,224.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,356.94,439.31,
HC PR ED 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM,Px00098110289,CDM,12053,CPT,981,RC,,,,OUTPATIENT,,,498,448.2,278.88,,,448.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,274.99,,,388.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.25,,,414.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.25,,,253.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.25,,,414.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.74,,,253.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.62,,,448.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.9,,,478.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.95,,,388.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,211.95,,,388.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.86,,,458.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.31,,,253.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,283.86,,,423.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,278.88,,,448.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,439.65,,,473.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,211.95,,,211.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,211.95,439.65,
ACETYLCYSTEINE INJ 200 MG/ML,Rx63323096341,CDM,J0132,HCPCS,636,RC,63323096341,NDC,,BOTH,1,ML,461.73,415.56,438.64,,,438.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,360.15,,,360.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,415.56,,,415.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,415.56,,,415.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,415.56,,,415.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,226.25,,,226.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,415.56,,,415.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,443.26,,,443.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,339.37,,,339.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,226.25,,,226.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,424.79,,,424.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,226.25,,,226.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,392.47,,,392.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,438.64,,,438.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,415.56,,,415.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,226.25,,,226.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.15,443.26,
ACETYLCYSTEINE INJ 200 MG/ML,Rx63323096344,CDM,J0132,HCPCS,636,RC,63323096344,NDC,,BOTH,1,ML,461.73,415.56,438.64,,,415.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.15,,,360.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.56,,,384.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.56,,,235.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.56,,,384.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,235.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.56,,,415.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.26,,,443.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.37,,,360.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,360.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.79,,,424.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,235.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.47,,,392.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.64,,,415.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.56,,,438.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.25,,,226.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.15,443.26,
HC ARM SLEEVE SHOULDER SUSPENSION SYSTEM,Sx0000AR-1651,CDM,,,270,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LOW PROFILE CORTEX 2.4X22MM,Sx0AR-8724-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LOW PROFILE CORTEX 2.4X14MM,Sx0AR-8724-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LO-PROFILE TI 3.0 X 18MMCORT,Sx0AR-8933-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LO-PROFILE TI 3.0 X 22MMCORT,Sx0AR-8933-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LO-PROFILE TI 3.0 X 20MMCORT,Sx0AR-8933-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LO-PROFILE TI 3.0 X 30MMCORT,Sx0AR-8933-30,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC SCREW LOW PROFILE CORTEX 2.4X24MM,Sx0AR-8724-24,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,462,415.8,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.36,,,360.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,235.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,384.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.64,,,360.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.04,,,425.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,235.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,392.7,,,392.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.9,,,415.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.8,,,438.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.38,,,226.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,360.36,443.52,
HC PR 15002 WOUND PREP TRK/ARM/LEG FIRST 100 SQ CM,Px00097510308,CDM,15002,CPT,975,RC,,,,BOTH,,,526,473.4,294.56,,,473.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,278.03,,,410.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.75,,,437.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.75,,,268.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.75,,,437.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.12,,,268.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.71,,,473.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,289.3,,,504.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,410.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,410.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.82,,,483.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,219.54,,,268.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.82,,,447.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,294.56,,,473.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,444.15,,,499.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.15,,,213.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,213.15,444.15,
HC LOCKING SCREW T7 2.7 X 24MM,Sx0053-27624E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,463.2,416.88,440.04,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.3,,,361.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,385.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,236.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,385.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,236.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.67,,,444.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.45,,,361.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.24,,,361.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.14,,,426.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,236.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.72,,,393.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.04,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,440.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,226.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,361.3,444.67,
HC LOCKING SCREW T7 2.7 X 26MM,Sx0053-27626E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,463.2,416.88,440.04,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.3,,,361.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,385.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,236.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,385.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,236.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.67,,,444.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.45,,,361.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,229.24,,,361.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.14,,,426.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,236.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.72,,,393.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.04,,,416.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,440.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,226.97,,,226.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,361.3,444.67,
HC INJ IV PUSH INITIAL DRUG,Px00094010207,CDM,96374,CPT,761,RC,,,,BOTH,,,464,417.6,440.8,,,417.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.92,,,361.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,386.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,236.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,386.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.36,,,236.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,417.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.44,,,445.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,341.04,,,361.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,227.36,,,361.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.88,,,426.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.36,,,236.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,394.4,,,394.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.8,,,417.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,440.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,227.36,,,227.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,361.92,445.44,
HC STAPLER LINEAR 33 TITANIUM STAPLES TLC10,Sx000000TLC10,CDM,,,270,RC,,,,BOTH,,,467.35,427.38,443.98,,,427.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,364.53,,,370.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.62,,,395.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.62,,,242,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.62,,,395.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229,,,242,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.62,,,427.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,448.66,,,455.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.5,,,370.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.29,,,370.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,429.96,,,436.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229,,,242,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.25,,,403.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.98,,,427.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.62,,,451.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229,,,229,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,364.53,448.66,
METHOTREXATE SOLN PREFILLED SYRINGE 10 MG/0.4ML,Rx66220081011,CDM,,,250,RC,66220-0810-11,NDC,,BOTH,0.4,ML,467.72,420.95,444.33,,,444.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,364.82,,,364.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,420.95,,,420.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,420.95,,,420.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,420.95,,,420.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,229.18,,,229.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,420.95,,,420.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,449.01,,,449.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,343.77,,,343.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,231.47,,,231.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,430.3,,,430.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,229.18,,,229.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,397.56,,,397.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,444.33,,,444.33,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,420.95,,,420.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,229.18,,,229.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,364.82,449.01,
HC PNEUMOTHORAX TRAY,Px00005747WNH,CDM,,,270,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC SCREW BONE 2.3X12MM TITNM IMPL CROSSPIN SELF TAP,Sx0052-23012E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC SCREW BONE 2.3X12MM TITNM EXPL CROSSPIN SELF TAP,Sx0052-23012E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC SCREW BONE TITNM 2.3X14MM IMPL CROSSPIN SELF TAP,Sx0052-23014E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC SCREW BONE 2.3X16MM TITNM IMPL CROSSPIN SELF TAP,Sx0052-23016E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC BONE SCREW 6.5X25 SELF TAP,Sx00-6250-065,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC BONE SCREW 6.5X30 SELF TAP,Sx00-6250-065,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC BONE SCREW 6.5X20 SELF TAP,Sx00-6250-065,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,468,421.2,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.04,,,365.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,238.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,389.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.98,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,231.61,,,365.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,238.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.32,,,229.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.04,449.28,
HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE #,Px00030100617,CDM,83013,CPT,300,RC,,,,BOTH,,,469,422.1,445.55,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.82,,,365.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,239,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,239,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.24,,,450.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.72,,,365.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,232.11,,,365.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,431.48,,,431.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,239,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.65,,,398.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.55,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,445.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,229.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.82,450.24,
HC HELICO PYLORI BREATH TEST,Px00030015065,CDM,83013,CPT,300,RC,,,,BOTH,,,469,422.1,445.55,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.82,,,365.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,239,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,239,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.24,,,450.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.72,,,365.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,232.11,,,365.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,431.48,,,431.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,239,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.65,,,398.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.55,,,422.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.1,,,445.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,229.81,,,229.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,365.82,450.24,
HC MESH PERFIX XL PLUG 1.6X2 BARD STERILE,Sx00000112780,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,469.5,422.55,446.03,,,422.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.21,,,366.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.55,,,390.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.55,,,239.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.55,,,390.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.06,,,239.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,422.55,,,422.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.72,,,450.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.08,,,366.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,232.36,,,366.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,431.94,,,431.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.06,,,239.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,399.08,,,399.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,446.03,,,422.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,422.55,,,446.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.06,,,230.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,366.21,450.72,
HC PR 24105 EXCISION OLECRANON BURSA CDM,Px00097500230,CDM,24105,CPT,975,RC,,,,BOTH,,,876.8,789.12,491.01,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,472.44,,,683.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,548,,,724.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,548,,,424.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,548,,,724.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,423.28,,,424.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,418.07,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,482.24,,,470.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.18,,,683.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,330.18,,,683.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,499.78,,,806.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,379.11,,,446.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,499.78,,,745.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,491.01,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,451.35,,,832.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.18,,,330.18,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,330.18,451.35,
HC POWDER HEMOSTATIC ARISTA 1 GR,Sx0SM0005-USA,CDM,,,270,RC,,,,BOTH,,,470.34,423.31,446.82,,,423.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,366.87,,,366.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.31,,,391.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.31,,,239.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.31,,,391.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.47,,,239.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,423.31,,,423.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.53,,,451.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.7,,,366.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,232.77,,,366.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432.71,,,432.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.47,,,239.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,399.79,,,399.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,446.82,,,423.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.31,,,446.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,230.47,,,230.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,366.87,451.53,
HC PROBE CONTOUR 3.5MM CRV RF 2,Sx279-350-301,CDM,,,270,RC,,,,BOTH,,,471.57,408.08,447.99,,,424.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.82,,,367.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.41,,,392.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.41,,,240.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.41,,,392.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.07,,,240.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.41,,,424.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.71,,,452.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.6,,,367.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,233.38,,,367.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,433.84,,,433.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.07,,,240.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,400.83,,,400.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,447.99,,,424.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.41,,,447.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.07,,,231.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,367.82,452.71,
HC SCREW LO-PRO LOCK TI 3.5X12MM,SxAR-8935L-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,472.5,425.25,448.88,,,425.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.55,,,368.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,425.25,,,393.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,425.25,,,240.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,425.25,,,393.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.53,,,240.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.25,,,425.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.29,,,368.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,233.84,,,368.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.53,,,240.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.63,,,401.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,448.88,,,425.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,425.25,,,448.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,231.53,,,231.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,368.55,453.6,
HC DRILL BIT 3.7MM,Sx000905-0046,CDM,,,270,RC,,,,BOTH,,,474,426.6,450.3,,,426.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,369.72,,,369.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.6,,,394.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.6,,,241.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.6,,,394.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.26,,,241.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.6,,,426.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.04,,,455.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.39,,,369.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.58,,,369.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,436.08,,,436.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.26,,,241.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.9,,,402.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.3,,,426.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.6,,,450.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,232.26,,,232.26,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,369.72,455.04,
HC LOCKING SCREW T7 2.3 X 20 MM,Sx0053-23620E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.3 X 22 MM,Sx0053-23622E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.3 X 12 MM,Sx0053-23612E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.7X12MM,Sx0053-27612E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.3 X 14 MM,Sx0053-23614E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.3 X 16 MM,Sx0053-23616E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC LOCKING SCREW T7 2.3 X 18 MM,Sx0053-23618E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,475.71,428.14,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.05,,,371.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,242.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,395.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.68,,,456.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.65,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,235.43,,,371.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.65,,,437.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,242.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.35,,,404.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.92,,,428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.14,,,451.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.1,,,233.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,371.05,456.68,
HC THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG CDM,Px00026010035,CDM,96374,CPT,761,RC,,,,BOTH,,,477,429.3,453.15,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.06,,,372.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,397.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,243.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,397.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,243.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.92,,,457.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.6,,,372.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,372.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,438.84,,,438.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,243.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405.45,,,405.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.15,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,453.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,233.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,372.06,457.92,
HC BONE SCREW T10 3.5X22MM,Sx00000614822,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,477,429.3,453.15,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.06,,,372.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,397.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,243.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,397.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,243.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.92,,,457.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,350.6,,,372.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,236.07,,,372.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,438.84,,,438.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,243.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,405.45,,,405.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.15,,,429.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.3,,,453.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,233.73,,,233.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,372.06,457.92,
HC PR ED 12054 INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM,Px00098110290,CDM,12054,CPT,981,RC,,,,OUTPATIENT,,,514,462.6,287.84,,,462.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,275.85,,,400.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,321.25,,,427.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,321.25,,,261.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,321.25,,,427.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,247.7,,,261.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.29,,,462.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,282.7,,,493.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,400.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,400.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.98,,,472.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,221.85,,,261.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,292.98,,,436.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,287.84,,,462.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,459.45,,,488.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.39,,,215.39,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,215.39,459.45,
HC IV HYDRATION INITIAL HR,Px00026010007,CDM,96360,CPT,761,RC,,,,BOTH,,,479,431.1,455.05,,,431.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.62,,,373.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.1,,,398.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.1,,,244.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.1,,,398.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.71,,,244.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,431.1,,,431.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459.84,,,459.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.07,,,373.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.71,,,373.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,440.68,,,440.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.71,,,244.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,407.15,,,407.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.05,,,431.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.1,,,455.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,234.71,,,234.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,373.62,459.84,
HC 45 DEG CURVE RIGHT FASTPASS LASSO,SxAR-6068-45R,CDM,,,270,RC,,,,BOTH,,,480,432,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.55,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441.6,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,374.4,460.8,
HC THREADED GUIDE WIRE ASNIS III 3.2X300MM,Sx00000702462,CDM,,,270,RC,,,,BOTH,,,480,432,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.55,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441.6,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,374.4,460.8,
HC DRILL TWIST 2.5MM DIA A0,Sx00060-25326,CDM,,,270,RC,,,,BOTH,,,480,432,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.55,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441.6,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,374.4,460.8,
HC DRILL 2.3 120MM,SxDRILL-2.3/1,CDM,,,270,RC,,,,BOTH,,,480,432,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.55,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441.6,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,374.4,460.8,
HC OMNI LOK CERVICAL SEAL,Sx0000OLK-100,CDM,,,270,RC,,,,BOTH,,,480,432,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.4,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,352.8,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.55,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441.6,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,235.2,,,235.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,374.4,460.8,
HC PR ED 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM,Px00098110881,CDM,27560,CPT,981,RC,,,,OUTPATIENT,,,1331,1197.9,745.36,,,1197.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,451.28,,,1038.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,831.88,,,1107.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,831.88,,,678.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,831.88,,,1107.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,402.2,,,678.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,398.12,,,1197.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,732.05,,,1277.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,1038.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,1038.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,758.67,,,1224.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,360.23,,,678.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,758.67,,,1131.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.36,,,1197.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.49,,,1264.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,349.74,,,349.74,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,349.74,463.49,
HC DRILL BIT 3.0MM,Sx0AR-8943-36,CDM,,,270,RC,,,,BOTH,,,483,434.7,458.85,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.74,,,376.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,402.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,246.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,402.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,246.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.68,,,463.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.01,,,376.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.04,,,376.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,444.36,,,444.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,246.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.55,,,410.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.85,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,458.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,236.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,376.74,463.68,
HC US ABD AORTA SCRN AAA,Px00040210142,CDM,76706,CPT,402,RC,,,,BOTH,,,483,434.7,458.85,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.74,,,376.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,402.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,246.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,402.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,246.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.68,,,463.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.01,,,376.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.04,,,376.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,444.36,,,444.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,246.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,410.55,,,410.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.85,,,434.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,434.7,,,458.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,236.67,,,236.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,376.74,463.68,
HC US BREAST UNI COMPLETE,Px00040210136,CDM,76641,CPT,402,RC,,,,BOTH,,,484,435.6,459.8,,,435.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,377.52,,,377.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,402.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,246.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,402.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.16,,,246.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,435.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.64,,,464.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.74,,,377.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,239.53,,,377.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.28,,,445.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.16,,,246.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.4,,,411.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459.8,,,435.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,459.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,237.16,,,237.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,377.52,464.64,
HC PR 58670 LAPAROSCOPY TUBAL CAUTERY,Px00097511112,CDM,58670,CPT,975,RC,,,,BOTH,,,897,807.3,502.32,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,439.05,,,699.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,746.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,746.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,417.99,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,425.9,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.35,,,861.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,699.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.29,,,825.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.37,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.29,,,762.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,502.32,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.3,,,852.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,393.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.5,465.3,
HC PR ED 24600 TREAT ELBOW DISLOCATION W/O ANESTH CDM,Px00098110713,CDM,24600,CPT,981,RC,,,,OUTPATIENT,,,813,731.7,455.28,,,731.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,437.47,,,634.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.13,,,676.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.13,,,414.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.13,,,676.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,403.83,,,414.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.75,,,731.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,447.15,,,780.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,351.16,,,634.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.16,,,634.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.41,,,747.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.69,,,414.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,463.41,,,691.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455.28,,,731.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.74,,,772.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,351.16,,,351.16,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,351.16,465.74,
HC XR UTERUS & FALLOPIAN TUBE W CONTRAST,Px00032010223,CDM,74740,CPT,320,RC,,,,BOTH,,,486,437.4,461.7,,,437.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.08,,,379.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.4,,,404.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.4,,,247.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.4,,,404.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,247.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.4,,,437.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,466.56,,,466.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,379.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,240.52,,,379.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,447.12,,,447.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,247.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,413.1,,,413.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,461.7,,,437.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.4,,,461.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.14,,,238.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,379.08,466.56,
HC PR 49500 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE CDM,Px00097500300,CDM,49500,CPT,975,RC,,,,BOTH,,,1002,901.8,561.12,,,901.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,574.58,,,781.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.25,,,834.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.25,,,510.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.25,,,834.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,471.96,,,510.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,491.25,,,901.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,551.1,,,961.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,781.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,781.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.14,,,921.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,422.71,,,510.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.14,,,851.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,561.12,,,901.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.55,,,951.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,467.55,
HC G7 APICAL HOLE PLUG,Sx00010000994,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,487.5,438.75,463.13,,,438.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,380.25,,,380.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,405.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,248.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,405.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.88,,,248.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,438.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,358.31,,,380.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.26,,,380.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,448.5,,,448.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.88,,,248.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,414.38,,,414.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.13,,,438.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,463.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,238.88,,,238.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,380.25,468,
HC US OB FOLLOW-UP PER FETUS,Px00040210023,CDM,76816,CPT,402,RC,,,,BOTH,,,489,440.1,464.55,,,440.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.42,,,381.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.1,,,407.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.1,,,249.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.1,,,407.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,249.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,440.1,,,440.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.44,,,469.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.42,,,381.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,242.01,,,381.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,449.88,,,449.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,249.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.65,,,415.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.55,,,440.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.1,,,464.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,239.61,,,239.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,381.42,469.44,
HC PR ED 26641 TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM,Px00098110775,CDM,26641,CPT,981,RC,,,,OUTPATIENT,,,1003,902.7,561.68,,,902.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,502.11,,,782.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.88,,,834.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.88,,,511.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.88,,,834.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,453.7,,,511.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.79,,,902.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,551.65,,,962.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,394.52,,,782.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,394.52,,,782.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.71,,,922.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,406.36,,,511.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.71,,,852.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,561.68,,,902.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.24,,,952.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,394.52,,,394.52,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,394.52,470.24,
HC PR ED 26742 CLOSED TX ARTICULAR FRACTURE W/MANIP CDM,Px00098110790,CDM,26742,CPT,981,RC,,,,OUTPATIENT,,,806,725.4,451.36,,,725.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,441.89,,,628.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.75,,,670.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.75,,,410.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.75,,,670.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,396.54,,,410.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,397.56,,,725.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,443.3,,,773.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.82,,,628.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,344.82,,,628.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,459.42,,,741.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,355.16,,,410.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,459.42,,,685.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,451.36,,,725.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,471.15,,,765.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.82,,,344.82,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,344.82,471.15,
HC FIXATION PIN TEMP 1.4X5MM,Sx00058820006,CDM,,,270,RC,,,,BOTH,,,492,442.8,467.4,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.76,,,383.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,409.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,250.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,409.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,250.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.32,,,472.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.62,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.49,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,452.64,,,452.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,250.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,418.2,,,418.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,467.4,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,467.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,241.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,383.76,472.32,
HC SCREW LOCKING T10 3.5X12MM IMP,Sx00040-35612,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,492,442.8,467.4,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.76,,,383.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,409.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,250.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,409.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,250.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.32,,,472.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.62,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.49,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,452.64,,,452.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,250.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,418.2,,,418.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,467.4,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.8,,,467.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.08,,,241.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,383.76,472.32,
HC DRILL 2.0MMX102MM WL50MM AO-SHAFT,Sx00045-47010,CDM,,,270,RC,,,,BOTH,,,492.8,443.52,468.16,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,384.38,,,384.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,410.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,251.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,410.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.47,,,251.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,473.09,,,473.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,362.21,,,384.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.89,,,384.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,453.38,,,453.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.47,,,251.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,418.88,,,418.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468.16,,,443.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.52,,,468.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,241.47,,,241.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,384.38,473.09,
HC PR ED 27840 CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM,Px00098110417,CDM,27840,CPT,981,RC,,,,OUTPATIENT,,,1473,1325.7,824.88,,,1325.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,492.21,,,1148.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,920.63,,,1226.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,920.63,,,750.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,920.63,,,1226.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.09,,,750.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,440.73,,,1325.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,810.15,,,1414.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,371.38,,,1148.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.38,,,1148.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,839.61,,,1355.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,382.52,,,750.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,839.61,,,1252.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,824.88,,,1325.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,473.4,,,1399.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,371.38,,,371.38,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,371.38,473.4,
HC DRILL BIT 2.4MM QC 100MM,Sx00000310.53,CDM,,,270,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC LO-PRO SCREW BLUNT TIP 4X26MM CANNULATED,Sx0AR-5051-26,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC LO-PRO SCREW BLUNT TIP 4X30MM CANNULATED,Sx0AR-5051-30,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC SCREW LOW PROFILE 4.0X40MM CANNUATED SHORT THREAD SS,SxAR-8840C-40,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC SCREW QCKFIX TI CANN ST CANC 4.0X40MM,SxAR-8740-40P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC SCREW QCKFIX TI CANN ST CANC 4.0X42MM,SxAR-8740-42P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC SCREW QCKFIX TI CANN ST CANC 4.0X34MM,SxAR-8740-34P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC SCREW QCFIX TI CANN ST CANC 4.0X30MM,SxAR-8740-30P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,495,445.5,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,386.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,252.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,412.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,363.83,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,244.98,,,386.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.4,,,455.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,252.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,420.75,,,420.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.25,,,445.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.5,,,470.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,242.55,,,242.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,386.1,475.2,
HC PR 27340 REMOVAL PREPATELLA BURSA [27340] CDM,Px00097500048,CDM,27340,CPT,975,RC,,,,BOTH,,,890,801,498.4,,,801,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,488.74,,,694.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,556.25,,,737.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,556.25,,,439.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,556.25,,,737.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,437.82,,,439.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,442.46,,,801,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.5,,,500.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,694.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,694.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.3,,,818.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,392.13,,,453.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.3,,,756.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.4,,,801,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,479.69,,,845.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,314.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,314.56,479.69,
HC OXYGEN HIGH FLOW PER DAY,Px00027015WNH,CDM,,,270,RC,,,,BOTH,,,500,450,475,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390,,,390,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,416.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,254.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,416.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,254.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,450,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480,,,480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,390,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.45,,,390,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460,,,460,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,254.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425,,,425,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,475,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,245,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,390,480,
HC FIBERLOOP NO 2 WITH FIBERTAG,Sx0000AR-7264,CDM,,,270,RC,,,,BOTH,,,500,450,475,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390,,,390,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,416.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,254.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,416.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,254.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,450,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480,,,480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,390,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.45,,,390,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460,,,460,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,254.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425,,,425,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475,,,450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450,,,475,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245,,,245,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,390,480,
HC CLAW II PLATE TACK,Sx00040250010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,501,450.9,475.95,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390.78,,,390.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,417.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,255.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,417.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,255.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.96,,,480.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.24,,,390.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.94,,,390.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460.92,,,460.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,255.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.85,,,425.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.95,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,475.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,245.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,390.78,480.96,
HC US OB < 14 WKS SINGLE FETUS,Px00040210014,CDM,76801,CPT,402,RC,,,,BOTH,,,501,450.9,475.95,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390.78,,,390.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,417.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,255.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,417.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,255.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.96,,,480.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.24,,,390.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,247.94,,,390.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460.92,,,460.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,255.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,425.85,,,425.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.95,,,450.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,450.9,,,475.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,245.49,,,245.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,390.78,480.96,
HC 25 DEG TIGHT CURVE RIGHT QUICKPASS LASSO,SxAR-6068-25T,CDM,,,270,RC,,,,BOTH,,,504,432,478.8,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.12,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.84,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.44,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,249.43,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,463.68,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.4,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.8,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,246.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,393.12,483.84,
HC 25 DEG TIGHT CURVE LEFT QUICKPASS LASSO,SxAR-6068-25T,CDM,,,270,RC,,,,BOTH,,,504,432,478.8,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.12,,,374.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,244.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,399.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.84,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.44,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,249.43,,,374.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,463.68,,,441.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,244.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.4,,,408,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.8,,,432,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,246.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,393.12,483.84,
HC 45 DEG CURVE LEFT QUICKPASS LASSO,SxAR-6068-45L,CDM,,,270,RC,,,,BOTH,,,504,453.6,478.8,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.12,,,393.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,419.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,256.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,419.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,256.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.84,,,483.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,370.44,,,393.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,249.43,,,393.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,463.68,,,463.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,256.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.4,,,428.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.8,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.6,,,478.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,246.96,,,246.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,393.12,483.84,
HC PR 45378 DIAGNOSTIC COLONOSCOPY,Px00097510766,CDM,45378,CPT,975,RC,,,,BOTH,,,430,387,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.28,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,268.75,,,354.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,204.21,,,205.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,224.85,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.5,,,294.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,335.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,395.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,182.9,,,219.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,245.1,,,365.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.8,,,387,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,484.65,,,408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.57,,,177.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,177.57,484.65,
HC DRILL TWIST 1.4 MM DIA AO,Sx00060-14326,CDM,,,270,RC,,,,BOTH,,,506.8,456.12,481.46,,,456.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.3,,,395.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.12,,,421.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.12,,,258.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.12,,,421.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.33,,,258.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,456.12,,,456.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.53,,,486.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,372.5,,,395.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,250.82,,,395.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,466.26,,,466.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.33,,,258.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,430.78,,,430.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.46,,,456.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.12,,,481.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,248.33,,,248.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,395.3,486.53,
"HC PR 43226 ESOPHAGUS ENDOSCOPY DILATION, W/ GUIDE WIRE",Px00097510292,CDM,43226,CPT,975,RC,,,,BOTH,,,948,853.2,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.44,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,145.16,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,157.03,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,521.4,,,910.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.23,,,739.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,126.23,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,872.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,130.02,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,805.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,486.9,,,900.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,126.23,,,126.23,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,126.23,486.9,
HC PR ED 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM,Px00098110277,CDM,12035,CPT,981,RC,,,,OUTPATIENT,,,566,509.4,316.96,,,509.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.99,,,441.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,353.75,,,471.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,353.75,,,288.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,353.75,,,471.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.56,,,288.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,286.43,,,509.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.3,,,543.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.01,,,441.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.01,,,441.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,322.62,,,520.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.12,,,288.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,322.62,,,481.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,316.96,,,509.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,487.8,,,537.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.01,,,237.01,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,237.01,487.8,
HC RECIP BLADE SMOOTHED 2.5 STRYKER HUB 11-3917,Sx00000737000,CDM,,,270,RC,,,,BOTH,,,510,459,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,259.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.4,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.2,,,469.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,433.5,,,433.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,484.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,249.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,397.8,489.6,
HC RECIP BLADE SMOOTHED 2.5 STRYKER HUB 11-3918,Sx00000737365,CDM,,,270,RC,,,,BOTH,,,510,459,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,259.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.4,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.2,,,469.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,433.5,,,433.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,484.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,249.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,397.8,489.6,
HC CENTRAL SCREW NL UNI REV 6.5X20MM,SxAR-9165-20N,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,510,459,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.8,,,397.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,259.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,424.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,374.85,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.4,,,397.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.2,,,469.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,259.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,433.5,,,433.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459,,,484.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,249.9,,,249.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,397.8,489.6,
HC PR ED 59820 CARE OF MISCARRIAGE,Px00098100009,CDM,59820,CPT,981,RC,,,,OUTPATIENT,,,1846,1661.4,1033.76,,,1661.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,430.77,,,1439.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1153.75,,,1536.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1153.75,,,940.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1153.75,,,1536.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,434.9,,,940.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.59,,,1661.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1015.3,,,1772.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.17,,,1439.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378.17,,,1439.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1052.22,,,1698.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.52,,,940.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1052.22,,,1569.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1033.76,,,1661.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.05,,,1753.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.17,,,378.17,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,378.17,490.05,
HC PR 55250 REMOVAL OF SPERM DUCT(S),Px00097511034,CDM,55250,CPT,975,RC,,,,BOTH,,,865,778.5,484.4,,,778.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,306.38,,,674.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.63,,,668.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.63,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.63,,,668.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,262.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.62,,,778.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,475.75,,,305.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.48,,,674.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,228.48,,,674.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.05,,,795.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,235.33,,,440.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.05,,,735.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,484.4,,,778.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.94,,,821.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,228.48,,,228.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,228.48,490.94,
HC DRILL 2.0X102MM WL50 AO SHAFT,Sx00045-27010,CDM,,,270,RC,,,,BOTH,,,512,460.8,486.4,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.36,,,399.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,260.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.88,,,260.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.52,,,491.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.32,,,399.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,253.39,,,399.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,471.04,,,471.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.88,,,260.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,435.2,,,435.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.4,,,460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.8,,,486.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,250.88,,,250.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,399.36,491.52,
CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG,Rx00456060001,CDM,J0712,HCPCS,636,RC,456060001,NDC,,BOTH,600,ME,512.47,461.22,486.85,,,461.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.73,,,399.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,461.22,,,426.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,461.22,,,261.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,461.22,,,426.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.11,,,261.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.22,,,461.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.97,,,491.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,376.67,,,399.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,251.11,,,399.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,471.47,,,471.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.11,,,261.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,435.6,,,435.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.85,,,461.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,461.22,,,486.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,251.11,,,251.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,399.73,491.97,
HC US PELVIC NON-OB COMPLETE,Px00040210093,CDM,76856,CPT,402,RC,,,,BOTH,,,515,463.5,489.25,,,463.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.7,,,401.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.5,,,428.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.5,,,262.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.5,,,428.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.35,,,262.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,463.5,,,463.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.4,,,494.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,378.53,,,401.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,254.87,,,401.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,473.8,,,473.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.35,,,262.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.75,,,437.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,489.25,,,463.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.5,,,489.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.35,,,252.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,401.7,494.4,
HC PROBE RF 2 90-S MAX 4MM 90 DEG,Sx279-401-100,CDM,,,270,RC,,,,BOTH,,,515.79,446.36,490,,,464.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.32,,,402.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.21,,,429.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.21,,,262.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.21,,,429.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.74,,,262.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,464.21,,,464.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.16,,,495.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.11,,,402.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.26,,,402.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,474.53,,,474.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.74,,,262.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,438.42,,,438.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,490,,,464.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.21,,,490,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,252.74,,,252.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,402.32,495.16,
HC ED REMOVE INTRAUTERINE DEVICE CDM,Px00045010455,CDM,58301,CPT,450,RC,,,,OUTPATIENT,,,520,369.9,494,,,406.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.6,,,352.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,377.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,377.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468,,,406.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.2,,,94.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,352.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.35,,,352.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.4,,,415.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,230.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442,,,384.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494,,,406.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,429.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,254.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.6,499.2,
HC RECIP SAWBLADE 8X50X1MM,Sx00351-91-03,CDM,,,270,RC,,,,BOTH,,,520,468,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.6,,,405.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,264.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.2,,,499.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.35,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.4,,,478.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442,,,442,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,254.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.6,499.2,
HC SAW-10X75X1.19-STRYKER,Sx00351-91-04,CDM,,,270,RC,,,,BOTH,,,520,468,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.6,,,405.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,264.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.2,,,499.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.35,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.4,,,478.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442,,,442,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,254.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.6,499.2,
HC TALON GRASPING DEVICE 2.5X160,Sx0BX00711175,CDM,,,270,RC,,,,BOTH,,,520,468,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.6,,,405.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,264.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.2,,,499.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.35,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.4,,,478.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442,,,442,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,254.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.6,499.2,
HC US RETROPERITONEAL COMPLETE,Px00040210010,CDM,76770,CPT,402,RC,,,,BOTH,,,520,468,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.6,,,405.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,264.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,432.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.2,,,499.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.35,,,405.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.4,,,478.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,264.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442,,,442,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,254.8,,,254.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.6,499.2,
HC TWIST DRILL 2.3MM QUICK COUPLING,Sx00060-23341,CDM,,,270,RC,,,,BOTH,,,520.48,468.43,494.46,,,468.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.97,,,405.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468.43,,,433.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468.43,,,265.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468.43,,,433.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.04,,,265.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.43,,,468.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.66,,,499.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.55,,,405.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,257.59,,,405.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.84,,,478.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.04,,,265.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.41,,,442.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.46,,,468.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468.43,,,494.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.04,,,255.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,405.97,499.66,
HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 110 UT/0.5ML,Rx13533063603,CDM,90371,CPT,636,RC,13533063603,NDC,,BOTH,0.5,ML,521.16,469.04,495.1,,,469.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,406.5,,,406.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.04,,,433.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.04,,,265.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.04,,,433.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.37,,,265.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.04,,,469.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.31,,,500.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.05,,,406.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,255.37,,,406.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.47,,,479.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.37,,,265.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.99,,,442.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.1,,,469.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.04,,,495.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.37,,,255.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,406.5,500.31,
HC BONE SCREW T7 2.3 X 24 MM,Sx0053-23224E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,522,469.8,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.16,,,407.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,266.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.12,,,501.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.67,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.24,,,480.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,443.7,,,443.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,495.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,255.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,407.16,501.12,
HC BONE SCREW T7 2.7X14MM,Sx0053-27214E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,522,469.8,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.16,,,407.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,266.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.12,,,501.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.67,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.24,,,480.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,443.7,,,443.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,495.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,255.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,407.16,501.12,
HC BONE SCREW T7 2.3 X 16 MM,Sx0053-23216E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,522,469.8,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.16,,,407.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,266.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.12,,,501.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.67,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.24,,,480.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,443.7,,,443.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,495.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,255.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,407.16,501.12,
HC BONE SCREW T7 2.7 X 24MM,Sx0053-27224E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,522,469.8,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.16,,,407.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,266.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.12,,,501.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,383.67,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,258.34,,,407.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.24,,,480.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,266.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,443.7,,,443.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.9,,,469.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.8,,,495.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,255.78,,,255.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,407.16,501.12,
HC RBC LEUKOREDUCED,Px00039010015,CDM,P9016,CPT,390,RC,,,,BOTH,,,524,457.2,497.8,,,471.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,408.72,,,408.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.6,,,436.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.6,,,267.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.6,,,436.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.76,,,267.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,471.6,,,471.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,503.04,,,503.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.14,,,408.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.33,,,408.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.08,,,482.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.76,,,267.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.4,,,445.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.8,,,471.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.6,,,497.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,256.76,,,256.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,408.72,503.04,
HC PR 28232 TX OPEN TENDON FLEXOR TOE 1 TENDON SPX CDM,Px00097500143,CDM,28232,CPT,975,RC,,,,BOTH,,,897,807.3,502.32,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,308.89,,,699.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,746.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,746.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.78,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.31,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.35,,,861.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.55,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.55,,,699.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.29,,,825.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.8,,,457.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.29,,,762.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,502.32,,,807.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.55,,,852.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.55,,,241.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,241.55,503.55,
HC DRILL BIT CANNULATED 3.0MM,SxAR-8945-30C,CDM,,,270,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC ACP KIT SERIES 1,Sx00ABS-10011,CDM,,,270,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC DESPOSABLE KIT FOR 2.9MM SHORT PUSHLOCK,Sx00AR-2923DS,CDM,,,270,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC DRILL BIT CANNULATED 2.6MM,Sx0AR-8943-02,CDM,,,270,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC TENDON GRAFT CUTTING BLADE 9MM,Sx0AR-2385-09,CDM,,,270,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC REFOBACIN BONE CEMENT R 1X40 US,Sx00110034355,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC SCREW TI 3.0 X 12MM VAL,SxAR-8933V-12,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC LO-PRO SCREW TI 4.5X40MM CANNULATED,SxAR-8945-40F,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC LO-PRO SCREW TI 4.5X45MM CANNULATED,SxAR-8945-45F,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC BONE CEMENT BIOMET  R 1X40 US,Sx00110034355,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC SCREW TI 3.0 X 10MM VAL,SxAR-8933V-10,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
HC SCREW TI 3.0 X 22MM VAL,SxAR-8933V-22,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,525,472.5,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,409.5,,,409.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,267.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,437.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,259.82,,,409.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483,,,483,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,267.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.25,,,446.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.75,,,472.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.5,,,498.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.25,,,257.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,409.5,504,
"HC PR ED 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, TRUNK CDM",Px00098110295,CDM,13101,CPT,981,RC,,,,OUTPATIENT,,,579,521.1,324.24,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,322.37,,,451.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,481.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,361.88,,,481.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,278.2,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.74,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,318.45,,,555.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.91,,,451.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,241.91,,,451.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.03,,,532.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,249.17,,,295.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.03,,,492.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.24,,,521.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,504.45,,,550.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.91,,,241.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,241.91,504.45,
HC CLIP RESOLUTION 235CM,Sx00000002261,CDM,,,270,RC,,,,BOTH,,,526.47,473.82,500.15,,,473.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.65,,,410.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,473.82,,,438.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,473.82,,,268.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,473.82,,,438.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.97,,,268.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,473.82,,,473.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.41,,,505.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.96,,,410.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,260.55,,,410.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.35,,,484.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.97,,,268.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,447.5,,,447.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.15,,,473.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,473.82,,,500.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,257.97,,,257.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,410.65,505.41,
HC DRILL TWIST 1.9 MM DIA AO,Sx00060-19326,CDM,,,270,RC,,,,BOTH,,,528,475.2,501.6,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.84,,,411.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,439.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,269.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,439.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,269.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,506.88,,,506.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.08,,,411.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.31,,,411.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,485.76,,,485.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,269.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,448.8,,,448.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.6,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,501.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,258.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,411.84,506.88,
HC DRILL TWIST 1.9X105MM AO,Sx00060-19340,CDM,,,270,RC,,,,BOTH,,,528,475.2,501.6,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.84,,,411.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,439.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,269.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,439.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,269.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,506.88,,,506.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,388.08,,,411.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.31,,,411.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,485.76,,,485.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,269.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,448.8,,,448.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.6,,,475.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.2,,,501.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,258.72,,,258.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,411.84,506.88,
HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE,Px00097510296,CDM,43239,CPT,975,RC,,,,BOTH,,,322,289.8,180.32,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.14,,,251.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,265.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,154.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.25,,,265.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,153.12,,,154.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,168.02,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.1,,,201.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,251.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,251.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.54,,,296.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,137.14,,,164.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.54,,,273.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,180.32,,,289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,305.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,133.15,,,133.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,133.15,507.6,
HC DRILL BIT 2.0X125MM SPS SMALL FRAGMENT,Sx00000700346,CDM,,,270,RC,,,,BOTH,,,530.4,477.36,503.88,,,477.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,413.71,,,413.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.36,,,441.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.36,,,270.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.36,,,441.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.9,,,270.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,477.36,,,477.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.18,,,509.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.84,,,413.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,262.49,,,413.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,487.97,,,487.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.9,,,270.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,450.84,,,450.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,503.88,,,477.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.36,,,503.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,259.9,,,259.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,413.71,509.18,
HC MESH PERFIX MED PLUG 1.3X1.55 BARD STERILE,Sx00000112760,CDM,,,274,RC,,,,BOTH,,,531.6,478.44,505.02,,,478.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.65,,,414.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.44,,,442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.44,,,270.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.44,,,442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.48,,,270.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,478.44,,,478.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.34,,,510.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,390.73,,,414.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.09,,,414.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.07,,,489.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.48,,,270.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,451.86,,,451.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.02,,,478.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.44,,,505.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.48,,,260.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,414.65,510.34,
HC HEADLESS TROCAR DRILL PIN 75MM,Sx00-5901-020,CDM,,,270,RC,,,,BOTH,,,532.5,479.25,505.88,,,467.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.35,,,404.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,432.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,264.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,432.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,264.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,467.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.2,,,498.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.39,,,404.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.53,,,404.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.9,,,477.655,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,264.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,452.63,,,441.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.88,,,467.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,493.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,260.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,415.35,511.2,
HC HEADLESS TROCAR DRILL PIN75MM,Sx00-5901-020,CDM,,,270,RC,,,,BOTH,,,532.5,455.28,505.88,,,467.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.35,,,404.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,432.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,264.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,432.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,264.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,467.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.2,,,498.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,391.39,,,404.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.53,,,404.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.9,,,477.655,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,264.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,452.63,,,441.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.88,,,467.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.25,,,493.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,260.93,,,260.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,415.35,511.2,
HC PROBE HOOK 3.5MM DIAM RF 2,Sx279-350-501,CDM,,,270,RC,,,,BOTH,,,533.64,480.28,506.96,,,480.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.24,,,416.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.28,,,444.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.28,,,271.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.28,,,444.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.48,,,271.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.28,,,480.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.29,,,512.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,392.23,,,416.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.1,,,416.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,490.95,,,490.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.48,,,271.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,453.59,,,453.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,506.96,,,480.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.28,,,506.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.48,,,261.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,416.24,512.29,
HC PR ED 27265 TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM,Px00098110854,CDM,27265,CPT,981,RC,,,,OUTPATIENT,,,978,880.2,547.68,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,525.4,,,762.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,814.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,814.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,269.23,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,474.92,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,537.9,,,938.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.11,,,762.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,234.11,,,762.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.46,,,899.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.13,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.46,,,831.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,547.68,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,512.55,,,929.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.11,,,234.11,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,234.11,512.55,
TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML,Rx63459091211,CDM,J1447,HCPCS,636,RC,63459091211,NDC,,BOTH,0.8,ML,534.24,481.17,507.53,,,480.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.71,,,416.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.82,,,444.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.82,,,272.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.82,,,444.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.78,,,272.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.82,,,480.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.87,,,512.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,392.67,,,416.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,261.78,,,416.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,491.5,,,491.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.78,,,272.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.1,,,454.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.53,,,480.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.82,,,507.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,261.78,,,261.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,416.71,512.87,
HC PR 28272 CAPSULOTOMY IPHAL JOINT EACH JOINT SPX CDM,Px00097500343,CDM,28272,CPT,975,RC,,,,BOTH,,,908,817.2,508.48,,,817.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319.7,,,708.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,567.5,,,712.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,567.5,,,290.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,567.5,,,712.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,288.88,,,290.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,302.79,,,817.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,499.4,,,345.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.2,,,708.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,251.2,,,708.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,517.56,,,835.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.74,,,462.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,517.56,,,771.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.48,,,817.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,513,,,862.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.2,,,251.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,251.2,513,
HC ED REPAIR SUPERFICL WOUND(S)< 2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM,Px00045010355,CDM,12001,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,61.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REMOVAL OF NAIL PLATE CDM,Px00045010348,CDM,11730,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,69.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REPAIR SUPERFICIAL WOUND(S) <2.5 FACE ERS EYLD NSE LPS MUC CDM,Px00045010361,CDM,12011,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,76.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK EXTR HN CDM,Px00045010356,CDM,12002,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,80.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM CDM,Px00045010357,CDM,12004,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM,Px00045010309,CDM,10060,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,386.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,129.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REPAIR SUPERFICIAL WOUND(S) 2.6-5.0CM FACE ERS EYLD NSE LPS MUC CDM,Px00045010362,CDM,12013,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REPAIR SUPERFICIAL WOUND(S) 5.1-7.5CM FACE ERS EYLD NSE LPS MUC CDM,Px00045010363,CDM,12014,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED REPAIR SUPERFICIAL WOUND(S) 7.6-12.5CM FACE ERS EYLD NSE LPS MUC CDM,Px00045010364,CDM,12015,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED DRESS/DEBRID P-THICK BURN S <5% TBSA CDM,Px00045010519,CDM,16020,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM,Px00045010520,CDM,16025,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC ED I+D FINGER ABSC-SIM-FA CDM,Px00045014005,CDM,26010,CPT,450,RC,,,,OUTPATIENT,,,535,380.7,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,362.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,236.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,387.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.6,,,446.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.23,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.77,,,362.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.2,,,427.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,236.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.75,,,395.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.25,,,418.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.5,,,441.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.15,,,262.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.3,513.6,
HC KIT DISPOSABLE 2.9MM PUSHLOCK,Sx00AR-1923DS,CDM,,,270,RC,,,,BOTH,,,535.5,481.95,508.73,,,481.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.69,,,417.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,445.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,272.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,445.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,272.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,481.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.08,,,514.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.59,,,417.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.02,,,417.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.66,,,492.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,272.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.18,,,455.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.73,,,481.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,508.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,262.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.69,514.08,
HC DISPOSABLE KIT FOR 3.5MM PUSHLOCK AR-1926DS,Sx00AR-1926DS,CDM,,,270,RC,,,,BOTH,,,535.5,481.95,508.73,,,481.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.69,,,417.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,445.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,272.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,445.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,272.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,481.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.08,,,514.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.59,,,417.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.02,,,417.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.66,,,492.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,272.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.18,,,455.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.73,,,481.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.95,,,508.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.4,,,262.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,417.69,514.08,
HC DRILL SOLID SIDE CUTTING 2X40 DISPOSABLE,SxDRLL-SSC-20,CDM,,,270,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC DRILL SOLID SIDE CUT 2.5X40MM DISPOSABLE,SxDRLL-SSC-25,CDM,,,270,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC DRIVER AO CONNECTION SQUARE TIP 2.0MM,SxDRVR-AOS-S2,CDM,,,270,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC DRIVER INIVERSAL QUICK CONNECT T10,SxDRVR-UQC-T1,CDM,,,270,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC DRILL CANNULATED POLYAXIAL LOCKING SCREW 2.0MM,SxDRLL-PLS-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC US OB DETAILED SINGLE FETUS,Px00040210018,CDM,76811,CPT,402,RC,,,,BOTH,,,536,482.4,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.08,,,418.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,273.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,446.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.56,,,514.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.27,,,418.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.12,,,493.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,273.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,455.6,,,455.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.2,,,482.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.4,,,509.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,262.64,,,262.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.08,514.56,
HC PR 58558 HYSTEROSCOPY BIOPSY,Px00097511103,CDM,58558,CPT,975,RC,,,,BOTH,,,554,498.6,310.24,,,498.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.5,,,432.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.25,,,455.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.25,,,259.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,346.25,,,455.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.11,,,259.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,275.89,,,498.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.7,,,368.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.57,,,432.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,223.57,,,432.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.78,,,509.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.28,,,282.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.78,,,470.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.24,,,498.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,514.8,,,526.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.57,,,223.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,223.57,514.8,
HC VALVE CHEST DRAIN,Sx00000G36370,CDM,,,270,RC,,,,BOTH,,,537.12,439.7,510.26,,,483.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,418.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.41,,,447.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.41,,,273.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.41,,,447.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.19,,,273.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483.41,,,483.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.64,,,515.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.78,,,418.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,265.82,,,418.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,494.15,,,494.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.19,,,273.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,456.55,,,456.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.26,,,483.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.41,,,510.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.19,,,263.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,418.95,515.64,
HC PR ED 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM,Px00098110572,CDM,23655,CPT,981,RC,,,,OUTPATIENT,,,952,856.8,533.12,,,856.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,533.95,,,742.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,595,,,792.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,595,,,485.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,595,,,792.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,357.22,,,485.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,477.78,,,856.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,523.6,,,913.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,742.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,742.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.64,,,875.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319.95,,,485.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.64,,,809.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,533.12,,,856.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,516.15,,,904.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,310.63,,,310.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,310.63,516.15,
METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML),Rx00517037401,CDM,Q9968,HCPCS,636,RC,517037401,NDC,,BOTH,10,ML,537.92,484.13,511.02,,,484.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,419.58,,,419.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.13,,,447.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.13,,,274.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.13,,,447.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.58,,,274.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.13,,,484.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,516.4,,,516.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,395.37,,,419.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,263.58,,,419.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,494.89,,,494.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.58,,,274.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.23,,,457.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.02,,,484.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.13,,,511.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,263.58,,,263.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,419.58,516.4,
HC EPIFIX ALLOGRAFT 5X6 PER CM,Px00012649WNH,CDM,Q4186,CPT,278,RC,,,,BOTH,,,539.55,485.6,512.57,,,485.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.85,,,420.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.6,,,449.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.6,,,274.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.6,,,449.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.38,,,274.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,485.6,,,485.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,517.97,,,517.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.57,,,420.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.02,,,420.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.39,,,496.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.38,,,274.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,458.62,,,458.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.57,,,485.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.6,,,512.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.38,,,264.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,420.85,517.97,
HC L&D TRIAGE NEW PATIENT LVL 2 CDM,Px00076100002,CDM,99202,CPT,761,RC,,,,BOTH,,,540,405,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,439.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,439.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,66.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM,Px00076110533,CDM,99213,CPT,761,RC,,,,BOTH,,,540,405,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,439.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,439.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,68.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC TRAY PNEUMOTHORAX 8FR  W/HEIMLICH VALVE **CONTAINS LATEX**,Sx000AK-01500,CDM,,,270,RC,,,,BOTH,,,540,486,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.25,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC SET SCREW HEX DRIVER 2MM,Sx00-5987-071,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,540,486,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.25,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC BONE SCREW T10 2.7X16MM,Sx00000614716,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,540,486,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.25,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC BONE SCREW T10 2.7X18MM,Sx00000614718,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,540,486,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.25,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
HC BONE SCREW T10 3.5X16MM,Sx00000614816,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,540,486,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,421.2,,,421.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,275.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,449.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,267.25,,,421.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,275.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459,,,459,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,486,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,264.6,,,264.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.2,518.4,
TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML,Rx63459091212,CDM,J1447,HCPCS,636,RC,63459091212,NDC,,BOTH,0.8,ML,540.22,486.2,513.21,,,513.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,421.37,,,421.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.2,,,486.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.2,,,486.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.2,,,486.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.71,,,264.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.2,,,486.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,518.61,,,518.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,397.06,,,397.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,264.71,,,264.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,497,,,497,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.71,,,264.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,459.19,,,459.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,513.21,,,513.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.2,,,486.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.71,,,264.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.37,518.61,
LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),Rx00009780701,CDM,J2020,HCPCS,636,RC,9780701,NDC,,BOTH,300,ML,540.67,486.6,513.64,,,513.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,421.72,,,421.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.6,,,486.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.6,,,486.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.6,,,486.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.93,,,264.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.6,,,486.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,519.04,,,519.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,397.39,,,397.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,264.93,,,264.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,497.42,,,497.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.93,,,264.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,459.57,,,459.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,513.64,,,513.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,486.6,,,486.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,264.93,,,264.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,421.72,519.04,
HC MESH PERFIX LARGE PLUG 0,Sx00000112770,CDM,,,274,RC,,,,BOTH,,,542.4,488.16,515.28,,,488.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.07,,,423.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.16,,,451.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.16,,,276.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.16,,,451.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.78,,,276.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.16,,,488.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,520.7,,,520.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.66,,,423.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.43,,,423.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.01,,,499.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.78,,,276.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.04,,,461.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.28,,,488.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.16,,,515.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.78,,,265.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,423.07,520.7,
HC TRAY CHEST TUBE OB INSERT,Sx00000G06791,CDM,,,270,RC,,,,BOTH,,,542.43,488.19,515.31,,,488.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.1,,,423.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.19,,,451.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.19,,,276.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.19,,,451.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.79,,,276.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.19,,,488.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,520.73,,,520.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.69,,,423.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,268.45,,,423.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.04,,,499.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.79,,,276.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.07,,,461.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.31,,,488.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.19,,,515.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,265.79,,,265.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,423.1,520.73,
HC PR 43248 EGD GUIDE WIRE INSERTION,Px00097510502,CDM,43248,CPT,975,RC,,,,BOTH,,,1008,907.2,564.48,,,907.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.65,,,786.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,630,,,757.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,630,,,185.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,630,,,757.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,183.59,,,185.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,201.94,,,907.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,554.4,,,243.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.64,,,786.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,159.64,,,786.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,927.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,164.43,,,513.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,856.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,564.48,,,907.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,522,,,957.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.64,,,159.64,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,159.64,522,
IBUTILIDE FUMARATE INJ 1 MG/10ML,Rx00009379401,CDM,J1742,HCPCS,636,RC,9379401,NDC,,BOTH,10,ML,544.86,454.41,517.62,,,490.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.99,,,425.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,490.37,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,490.37,,,277.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,490.37,,,453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.98,,,277.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,490.37,,,490.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.07,,,523.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,400.47,,,425.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,266.98,,,425.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,501.27,,,501.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.98,,,277.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,463.13,,,463.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,517.62,,,490.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,490.37,,,517.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,266.98,,,266.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,424.99,523.07,
HC SET NEEDLE 25MM,Px00009896WNH,CDM,,,270,RC,,,,BOTH,,,546.4,491.76,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.19,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,278.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.54,,,524.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.6,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.41,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,502.69,,,502.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,464.44,,,464.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,519.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,267.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,426.19,524.54,
HC SET NEEDLE 15MM EZ-IO PINK,Sx9018-VC-005,CDM,,,270,RC,,,,BOTH,,,546.4,564.3,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.19,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,278.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.54,,,524.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.6,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.41,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,502.69,,,502.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,464.44,,,464.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,519.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,267.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,426.19,524.54,
HC SET NEEDLE 25MM EZ-IO BLUE,Sx9001-VC-005,CDM,,,270,RC,,,,BOTH,,,546.4,564.3,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.19,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,278.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.54,,,524.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.6,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.41,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,502.69,,,502.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,464.44,,,464.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,519.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,267.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,426.19,524.54,
HC SET NEEDLE 45MM EZ-IO YELLOW,Sx9079-VC-005,CDM,,,270,RC,,,,BOTH,,,546.4,564.3,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.19,,,426.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,278.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,454.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.54,,,524.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,401.6,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,270.41,,,426.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,502.69,,,502.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,278.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,464.44,,,464.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,519.08,,,491.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.76,,,519.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,267.74,,,267.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,426.19,524.54,
HC PR 24071 EXC ARM/ELBOW LES SC 3+ CM,Px00096910531,CDM,24071,CPT,983,RC,,,,BOTH,,,966,869.4,540.96,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,517.36,,,753.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,797,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,463.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,797,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,462.51,,,463.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,484.02,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.3,,,547.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.09,,,753.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,426.09,,,753.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,888.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.25,,,492.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,821.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,917.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.09,,,426.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,426.09,526.5,
HC POWERPICC SOLO 5FR SALINE FLUSHED VALVED,Sx0009295108D,CDM,,,270,RC,,,,BOTH,,,548.79,493.91,521.35,,,493.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.06,,,428.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.91,,,456.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.91,,,279.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.91,,,456.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.91,,,279.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.91,,,493.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.84,,,526.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,403.36,,,428.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,271.6,,,428.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504.89,,,504.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.91,,,279.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,466.47,,,466.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.35,,,493.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.91,,,521.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,268.91,,,268.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,428.06,526.84,
HC DRILL BIT 3.2mm CANNULATED,Sx0AR-8750-04,CDM,,,270,RC,,,,BOTH,,,551.25,496.13,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,429.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,280.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.17,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.81,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.56,,,468.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,523.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,270.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,429.98,529.2,
HC DRILL BIT 5.0mm CANNULATED,Sx0AR-8770-02,CDM,,,270,RC,,,,BOTH,,,551.25,496.13,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,429.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,280.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.17,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.81,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.56,,,468.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,523.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,270.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,429.98,529.2,
HC SCREW TI 3.0 X 16MM VAL,SxAR-8933V-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,551.25,496.13,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,429.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,280.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.17,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.81,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.56,,,468.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,523.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,270.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,429.98,529.2,
HC SCREW TI 3.0 X 14MM VAL,SxAR-8933V-14,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,551.25,496.13,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,429.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,280.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.17,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.81,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.56,,,468.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,523.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,270.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,429.98,529.2,
HC SCREW TI 3.0 X 18MM VAL,SxAR-8933V-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,551.25,496.13,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,429.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,280.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,458.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.17,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.81,,,429.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,280.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,468.56,,,468.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.69,,,496.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.13,,,523.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.11,,,270.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,429.98,529.2,
HC TIGHTROPE ABS IMPLANT,Sx00AR-1588TN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,552,496.8,524.4,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,459.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,281.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,459.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,281.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,430.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.18,,,430.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.84,,,507.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,281.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.2,,,469.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.4,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,524.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,270.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,430.56,529.92,
HC SCREW POLYAXIAL LOCK 2.5X22MM,SxPALS-25220-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,552,496.8,524.4,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,430.56,,,430.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,459.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,281.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,459.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,281.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,430.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.18,,,430.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.84,,,507.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,281.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.2,,,469.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.4,,,496.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,496.8,,,524.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.48,,,270.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,430.56,529.92,
HC EPIFIX ALLOGRAFT 7X7 PER CM,Px00012811WNH,CDM,Q4186,CPT,278,RC,,,,BOTH,,,552.58,497.32,524.95,,,497.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.01,,,431.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.32,,,459.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.32,,,281.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.32,,,459.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.76,,,281.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.32,,,497.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.48,,,530.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,406.15,,,431.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.47,,,431.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.37,,,508.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.76,,,281.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.69,,,469.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.95,,,497.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.32,,,524.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.76,,,270.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,431.01,530.48,
HC ED CHEMICAL CAUTERY TISSUE CDM,Px00045010525,CDM,17250,CPT,450,RC,,,,OUTPATIENT,,,553,393.3,525.35,,,432.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,431.34,,,375.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.7,,,400.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.7,,,245.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.7,,,400.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.97,,,245.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.7,,,432.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.88,,,461.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,406.46,,,375.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,273.68,,,375.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.76,,,442.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.97,,,245.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.05,,,408.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,525.35,,,432.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.7,,,456.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,270.97,,,270.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,431.34,530.88,
HC PR 28234 TENOTOMY EXT TEND FOOT,Px00097511537,CDM,28234,CPT,975,RC,,,,BOTH,,,974,876.6,545.44,,,876.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.13,,,759.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,608.75,,,810.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,608.75,,,496.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,608.75,,,810.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,313.58,,,496.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.18,,,876.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,535.7,,,935.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.68,,,759.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,272.68,,,759.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,555.18,,,896.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,280.86,,,496.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,555.18,,,827.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,545.44,,,876.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531,,,925.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.68,,,272.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,272.68,531,
HC PR 43247 OPERATIVE UPPER GI ENDOSCOPY W/ FB REMOVAL,Px00097510501,CDM,43247,CPT,975,RC,,,,BOTH,,,412,370.8,230.72,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.02,,,321.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,342.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,257.5,,,342.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.98,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,215.81,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,226.6,,,395.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.55,,,321.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.55,,,321.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.84,,,379.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.64,,,209.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,234.84,,,350.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,230.72,,,370.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.9,,,391.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.55,,,169.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,169.55,531.9,
HC 2.0MM T1 CORTEX SCREW SLF TAP 6MM,Sx0401.806.96,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,555,499.5,527.25,,,499.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.9,,,432.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.5,,,461.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.5,,,282.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.5,,,461.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.95,,,282.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.5,,,499.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,532.8,,,532.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,407.93,,,432.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.67,,,432.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.6,,,510.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.95,,,282.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,471.75,,,471.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.25,,,499.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.5,,,527.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,271.95,,,271.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,432.9,532.8,
HC PR 44392 COLONOSCOPY & POLYPECTOMY,Px00097510721,CDM,44392,CPT,975,RC,,,,BOTH,,,941,846.9,526.96,,,846.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.75,,,733.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,588.13,,,718.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,588.13,,,221.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,588.13,,,718.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,220.18,,,221.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,241.16,,,846.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,517.55,,,299.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.46,,,733.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,191.46,,,733.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,536.37,,,865.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,197.2,,,479.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,536.37,,,799.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,526.96,,,846.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,535.05,,,893.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.46,,,191.46,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,191.46,535.05,
HC PR 43215 ESOPHAGOSCOPY FLEX REMOVE FB,Px00097510289,CDM,43215,CPT,975,RC,,,,BOTH,,,346,311.4,193.76,,,311.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,191.03,,,269.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.25,,,288.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.25,,,176.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.25,,,288.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.83,,,176.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.99,,,311.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,190.3,,,332.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.37,,,269.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,136.37,,,269.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,197.22,,,318.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,140.46,,,176.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,197.22,,,294.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.76,,,311.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,535.95,,,328.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.37,,,136.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,136.37,535.95,
HC IV INFUSION INITIAL HR,Px00026010009,CDM,96365,CPT,761,RC,,,,BOTH,,,560,419.4,532,,,419.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.8,,,363.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,387.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,237.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,387.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,237.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504,,,419.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.6,,,447.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.6,,,363.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,363.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.2,,,428.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,237.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,476,,,396.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,532,,,419.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,442.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,274.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,436.8,537.6,
HC SUREFIRE SCORPION NEEDLE,Sx00AR-13991N,CDM,,,270,RC,,,,BOTH,,,560,504,532,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.8,,,436.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,466.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,285.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,466.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,285.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.6,,,537.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.6,,,436.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.14,,,436.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.2,,,515.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,285.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,476,,,476,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,532,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,532,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,274.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,436.8,537.6,
HC APOLLO RF MP50 MULTI PORT ASPIRATING ABLATOR 50 DEG,Sx0000AR-9815,CDM,,,270,RC,,,,BOTH,,,560,504,532,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.8,,,436.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,466.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,285.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,466.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,285.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.6,,,537.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,411.6,,,436.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.14,,,436.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.2,,,515.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,285.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,476,,,476,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,532,,,504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504,,,532,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.4,,,274.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,436.8,537.6,
HC PR ED 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM,Px00098110278,CDM,12036,CPT,981,RC,,,,OUTPATIENT,,,667,600.3,373.52,,,600.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,359.38,,,520.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,555.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,339.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.88,,,555.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.61,,,339.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,333.95,,,600.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,366.85,,,640.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.18,,,520.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276.18,,,520.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,380.19,,,613.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,284.47,,,339.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,380.19,,,566.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.52,,,600.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,537.75,,,633.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,276.18,,,276.18,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,276.18,537.75,
HC PR 27632 EXC LEG/ANKLE LES SC 3+ CM,Px00097510956,CDM,27632,CPT,975,RC,,,,BOTH,,,978,880.2,547.68,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,525.13,,,762.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,814.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.25,,,814.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,466.26,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.42,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,537.9,,,938.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,762.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,762.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.46,,,899.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,417.6,,,498.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.46,,,831.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,547.68,,,880.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,537.75,,,929.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,360.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,360.34,537.75,
HC US EXAM ABDOMEN COMPLETE,Px00040210008,CDM,76700,CPT,402,RC,,,,BOTH,,,561,504.9,532.95,,,504.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.58,,,437.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504.9,,,466.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504.9,,,285.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504.9,,,466.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.89,,,285.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504.9,,,504.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.56,,,538.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,412.34,,,437.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,277.64,,,437.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.12,,,516.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.89,,,285.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,476.85,,,476.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,532.95,,,504.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504.9,,,532.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,274.89,,,274.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,437.58,538.56,
HC PR 26111 EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>,Px00098210070,CDM,26111,CPT,982,RC,,,,BOTH,,,985,886.5,551.6,,,886.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,536.88,,,768.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.63,,,814.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.63,,,481.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.63,,,814.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.39,,,481.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.45,,,886.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,541.75,,,561.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,768.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,768.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,561.45,,,906.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.16,,,501.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,561.45,,,837.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,551.6,,,886.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,935.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,298.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,298.21,538.65,
HC ROM (AMNISURE),Px00030011747,CDM,84112,CPT,300,RC,,,,BOTH,,,562,505.8,533.9,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.36,,,438.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.8,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.8,,,286.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.8,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.38,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,505.8,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.52,,,539.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,413.07,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,278.13,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,517.04,,,517.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.38,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,477.7,,,477.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,533.9,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.8,,,533.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,275.38,,,275.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,438.36,539.52,
HC PR ED 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANIP CDM,Px00098110405,CDM,27788,CPT,981,RC,,,,OUTPATIENT,,,923,830.7,516.88,,,830.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.31,,,719.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.88,,,768.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.88,,,470.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.88,,,768.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,452.24,,,470.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455.63,,,830.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.65,,,886.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,719.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,719.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,526.11,,,849.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,405.05,,,470.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,526.11,,,784.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,516.88,,,830.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.45,,,876.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,393.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.25,540.45,
ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT),Rx42023022189,CDM,J1335,HCPCS,636,RC,42023022189,NDC,,BOTH,1,GR,564,507.6,535.8,,,507.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,439.92,,,439.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,469.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,287.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,469.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.36,,,287.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,507.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.44,,,541.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,414.54,,,439.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276.36,,,439.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,518.88,,,518.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.36,,,287.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.4,,,479.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.8,,,507.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.6,,,535.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.36,,,276.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,439.92,541.44,
HC PR ED 27781 CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM,Px00098110900,CDM,27781,CPT,981,RC,,,,OUTPATIENT,,,1565,1408.5,876.4,,,1408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,524.06,,,1220.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,978.13,,,1302.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,978.13,,,797.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,978.13,,,1302.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,475.51,,,797.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.91,,,1408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,860.75,,,1502.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,413.49,,,1220.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,413.49,,,1220.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,892.05,,,1439.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,425.89,,,797.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,892.05,,,1330.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,876.4,,,1408.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.25,,,1486.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,413.49,,,413.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,413.49,542.25,
HC APPLY RIGID LEG CAST,Px00076110293,CDM,29445,CPT,761,RC,,,,BOTH,,,565,508.5,536.75,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.7,,,440.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,470.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,287.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,470.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,287.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,542.4,,,542.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.28,,,440.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,440.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.8,,,519.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,287.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.25,,,480.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,536.75,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,536.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,276.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,440.7,542.4,
HC APPLICATION RIGID TOTAL CONTACT LEG CAST,Px00076110090,CDM,29445,CPT,761,RC,,,,BOTH,,,565,508.5,536.75,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.7,,,440.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,470.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,287.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,470.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,287.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,542.4,,,542.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,415.28,,,440.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,440.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.8,,,519.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,287.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,480.25,,,480.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,536.75,,,508.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.5,,,536.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,276.85,,,276.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,440.7,542.4,
HC ED PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT CDM,Px00045010003,CDM,94640,CPT,450,RC,,,,OUTPATIENT,,,566,402.3,537.7,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441.48,,,383.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.4,,,405.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.4,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.4,,,405.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.34,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,509.4,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.36,,,24.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.01,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.11,,,383.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,520.72,,,452.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.34,,,250.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.1,,,418.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.7,,,442.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.4,,,467.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.34,,,277.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,441.48,543.36,
HC DRILL BIT 3.6X122MM AO FITTNG,Sx00045-35020,CDM,,,270,RC,,,,BOTH,,,566.4,509.76,538.08,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441.79,,,441.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,471.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,288.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,471.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,288.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.74,,,543.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.3,,,441.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.31,,,441.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,521.09,,,521.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,288.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.44,,,481.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.08,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,538.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,277.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,441.79,543.74,
HC DRILL BIT 2.8MMX102MM AO FIT,Sx00045-27020,CDM,,,270,RC,,,,BOTH,,,566.4,509.76,538.08,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441.79,,,441.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,471.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,288.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,471.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,288.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.74,,,543.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.3,,,441.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.31,,,441.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,521.09,,,521.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,288.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,481.44,,,481.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.08,,,509.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.76,,,538.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,277.54,,,277.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,441.79,543.74,
HC PR 13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM  CDM,Px00097514017,CDM,13121,CPT,975,RC,,,,BOTH,,,598,538.2,334.88,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.09,,,466.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,497.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,497.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.59,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319.38,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.9,,,574.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,466.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,466.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.86,,,550.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.27,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.86,,,508.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.88,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,544.5,,,568.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,252.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,252.69,544.5,
HC PR ED 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX SCLP ARM L CDM,Px00098110298,CDM,13121,CPT,981,RC,,,,OUTPATIENT,,,598,538.2,334.88,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.09,,,466.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,497.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,373.75,,,497.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,290.59,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,319.38,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,328.9,,,574.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,466.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,466.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.86,,,550.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.27,,,304.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,340.86,,,508.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,334.88,,,538.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,544.5,,,568.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,252.69,,,252.69,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,252.69,544.5,
HC PR 23071 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>  CDM,Px00097514035,CDM,23071,CPT,975,RC,,,,BOTH,,,999,899.1,559.44,,,899.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,535.12,,,779.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,624.38,,,824.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,624.38,,,480.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,624.38,,,824.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.95,,,480.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,500.03,,,899.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,549.45,,,564.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.03,,,779.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,374.03,,,779.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,569.43,,,919.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.97,,,509.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,569.43,,,849.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,559.44,,,899.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,544.5,,,949.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,374.03,,,374.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,374.03,544.5,
HC SUCTION CRUISE 90-S SERFAS,Sx279-401-200,CDM,,,270,RC,,,,BOTH,,,567.75,510.98,539.36,,,510.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.85,,,442.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.98,,,472.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.98,,,289.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.98,,,472.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.2,,,289.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.98,,,510.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.04,,,545.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,417.3,,,442.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,280.98,,,442.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.33,,,522.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.2,,,289.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.59,,,482.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.36,,,510.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.98,,,539.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.2,,,278.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,442.85,545.04,
HC CT HEAD/BRAIN WO CONTRAST,Px00035110002,CDM,70450,CPT,350,RC,,,,BOTH,,,850,512.1,540.55,,,765,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.82,,,663,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.1,,,705.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.1,,,433.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.1,,,705.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.81,,,433.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,512.1,,,765,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,546.24,,,816,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.22,,,663,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.6,,,663,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,523.48,,,782,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.81,,,433.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483.65,,,722.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.55,,,765,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.1,,,807.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,278.81,,,416.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,443.82,546.24,
HC LINEAR RELOAD VASECR35 35MM ENDOSCOPIC VASCULAR WHT,Sx000VASECR35,CDM,,,270,RC,,,,BOTH,,,569.69,535.9,541.21,,,535.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.36,,,464.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.72,,,495.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.72,,,303.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.72,,,495.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.15,,,303.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,512.72,,,535.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,546.9,,,571.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.72,,,464.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,281.94,,,464.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,524.11,,,547.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.15,,,303.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.24,,,506.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.21,,,535.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.72,,,565.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.15,,,279.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,444.36,546.9,
HC POWERPICC SOLO 5FR,Px00008611WNH,CDM,C1751,CPT,270,RC,,,,BOTH,,,570,513,541.5,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.6,,,444.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,474.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,290.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,474.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.3,,,290.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,513,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.2,,,547.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,444.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.09,,,444.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,524.4,,,524.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.3,,,290.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.5,,,484.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.5,,,513,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513,,,541.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.3,,,279.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,444.6,547.2,
HC SET NEEDLE 15MM,Px00009895WNH,CDM,,,270,RC,,,,BOTH,,,570.4,513.36,541.88,,,513.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,444.91,,,444.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.36,,,474.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.36,,,290.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.36,,,474.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.5,,,290.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,513.36,,,513.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.58,,,547.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,419.24,,,444.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.29,,,444.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,524.77,,,524.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.5,,,290.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.84,,,484.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.88,,,513.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.36,,,541.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.5,,,279.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,444.91,547.58,
HC US JOINT COMPLETE,Px00040210041,CDM,76881,CPT,402,RC,,,,BOTH,,,571,513.9,542.45,,,513.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.38,,,445.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.9,,,475.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.9,,,290.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.9,,,475.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.79,,,290.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,513.9,,,513.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,548.16,,,548.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,419.69,,,445.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,282.59,,,445.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,525.32,,,525.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.79,,,290.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,485.35,,,485.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,542.45,,,513.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.9,,,542.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,279.79,,,279.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,445.38,548.16,
HC PR 25071 EXC FOREARM LES SC 3 CM,Px00097510022,CDM,25071,CPT,975,RC,,,,BOTH,,,1011,909.9,566.16,,,909.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.94,,,788.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.88,,,841.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.88,,,515.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.88,,,841.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,485.24,,,515.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,506.24,,,909.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,556.05,,,970.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.74,,,788.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,156.74,,,788.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.27,,,930.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,434.61,,,515.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.27,,,859.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.16,,,909.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,551.25,,,960.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,156.74,,,156.74,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,156.74,551.25,
HC DRILL BIT 1.8MM QC 110MM DEPTH MARK,Sx0000310-509,CDM,,,270,RC,,,,BOTH,,,576,518.4,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,293.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.96,,,552.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.36,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.06,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,547.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,282.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,449.28,552.96,
HC BONE SCREW T8 FULL THREAD 2.4MM L14MM,Sx00000656114,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,576,518.4,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,293.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.96,,,552.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.36,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.06,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,547.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,282.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,449.28,552.96,
HC BONE SCREW T8 FULL THREAD 2.4MM L22MM,Sx00000656122,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,576,518.4,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,293.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.96,,,552.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.36,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.06,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,547.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,282.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,449.28,552.96,
HC BONE SCREW T8 FULL THREAD 2.4MM L24MM,Sx00000656124,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,576,518.4,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,449.28,,,449.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,293.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,479.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.96,,,552.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,423.36,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,285.06,,,449.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.92,,,529.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,293.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.6,,,489.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.2,,,518.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.4,,,547.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,282.24,,,282.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,449.28,552.96,
"HC PR 64721 CARPAL TUNNEL SURGERY, SEPARATE PROC",Px00097510869,CDM,64721,CPT,975,RC,,,,BOTH,,,1030,927,576.8,,,927,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,562.16,,,803.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,643.75,,,853.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,643.75,,,508.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,643.75,,,853.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.05,,,508.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,508.85,,,927,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.5,,,574.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,440.91,,,803.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,440.91,,,803.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,587.1,,,947.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,454.14,,,524.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,587.1,,,875.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.8,,,927,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,553.95,,,978.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,440.91,,,440.91,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,440.91,553.95,
HC DRILL 2.6X122MM WL70MM AO SHFT,Sx00045-35010,CDM,,,270,RC,,,,BOTH,,,579.6,521.64,550.62,,,521.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.09,,,452.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.64,,,482.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.64,,,295.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.64,,,482.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284,,,295.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,521.64,,,521.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.42,,,556.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.01,,,452.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,286.84,,,452.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,533.23,,,533.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284,,,295.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.66,,,492.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,521.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.64,,,550.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284,,,284,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,452.09,556.42,
HC PR ED 24655 CLOSED TX RADIUS HD FRACTURE CDM,Px00098110720,CDM,24655,CPT,981,RC,,,,OUTPATIENT,,,1581,1422.9,885.36,,,1422.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,525.59,,,1233.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.13,,,1316.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.13,,,805.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.13,,,1316.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.31,,,805.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,472.85,,,1422.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.55,,,1517.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.92,,,1233.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.92,,,1233.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,901.17,,,1454.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.4,,,805.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,901.17,,,1343.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,885.36,,,1422.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.1,,,1501.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.92,,,415.92,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.92,557.1,
HC MODULATOR O2 FLOW SET ENK O2 FLOW SET,Sx0C-EFMS-100,CDM,,,270,RC,,,,BOTH,,,580.36,522.32,551.34,,,522.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.68,,,452.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.32,,,483.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.32,,,295.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.32,,,483.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.38,,,295.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.32,,,522.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,557.15,,,557.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,426.56,,,452.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.22,,,452.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,533.93,,,533.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.38,,,295.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.31,,,493.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.34,,,522.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.32,,,551.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.38,,,284.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,452.68,557.15,
"HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL",Px00097510880,CDM,49650,CPT,975,RC,,,,BOTH,,,1031,927.9,577.36,,,927.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,594.54,,,804.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,644.38,,,858.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,644.38,,,525.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,644.38,,,858.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.61,,,525.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,510.82,,,927.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,567.05,,,989.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,804.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,804.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,587.67,,,948.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.52,,,525.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,587.67,,,876.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,577.36,,,927.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.55,,,979.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,557.55,
HC APPLICATION CAST ELBOW FINGER SHORT ARM,Px00076110588,CDM,29075,CPT,761,RC,,,,BOTH,,,581,522.9,551.95,,,522.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.18,,,453.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.9,,,468.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.9,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.9,,,468.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.69,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.9,,,522.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,557.76,,,84.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.04,,,453.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,284.69,,,453.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,534.52,,,534.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.69,,,296.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,493.85,,,493.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.95,,,522.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,522.9,,,551.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.69,,,284.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,453.18,557.76,
HC PR 26020 DRAIN HAND TENDON SHEATH,Px00097510468,CDM,26020,CPT,975,RC,,,,BOTH,,,1321,1188.9,739.76,,,1188.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,722.86,,,1030.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,825.63,,,1099.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,825.63,,,673.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,825.63,,,1099.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,645.16,,,673.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,516.17,,,1188.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,726.55,,,1268.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,1030.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,1030.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.97,,,1215.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,577.84,,,673.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.97,,,1122.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,739.76,,,1188.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.99,,,1254.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,185.47,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,185.47,557.99,
HC CATHETER MIDLINE 4FR 20CM 2-LUM W/GUARDIVA PROBE COVER,SxS4254108DGP,CDM,,,270,RC,,,,BOTH,,,581.4,523.26,552.33,,,523.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,453.49,,,453.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.26,,,483.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.26,,,296.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.26,,,483.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.89,,,296.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,523.26,,,523.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558.14,,,558.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.33,,,453.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,287.73,,,453.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,534.89,,,534.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.89,,,296.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,494.19,,,494.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.33,,,523.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.26,,,552.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,284.89,,,284.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,453.49,558.14,
HC APOLLO RF HOOK 90 DEG NON ASPIRATING,Sx0000AR-9825,CDM,,,270,RC,,,,BOTH,,,582.75,504,553.61,,,524.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,454.55,,,454.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.48,,,485.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.48,,,296.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.48,,,485.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285.55,,,296.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,524.48,,,524.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.44,,,559.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,428.32,,,454.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,288.4,,,454.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,536.13,,,536.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285.55,,,296.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,495.34,,,495.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.61,,,524.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,524.48,,,553.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,285.55,,,285.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,454.55,559.44,
HC HD SCORPION NEEDLE,SxAR-13999HDN,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
HC SCORPION NEEDLE KNEE,Sx00AR-12990N,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
HC 2.4MM S-TAK PERC INSERT DISP KIT,Sx00AR-1934PI,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
HC SCORPION MULTIFIRE NEEDLE,SxAR-13999HDN,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
HC DRILL 9.5MM CANNULATED,Sx0AR-1218-95,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
HC DRILL BIT 2.0mm CMP FT CALIBRATED,Sx0AR-8737-34,CDM,,,270,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
"HC FIBERTAPE 17"" W/STR NDL",SxAR-7237-17L,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,585,526.5,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,456.3,,,456.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,298.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,486.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,429.98,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.52,,,456.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,298.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.25,,,497.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.75,,,526.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.5,,,555.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,286.65,,,286.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,456.3,561.6,
DINOPROSTONE VAGINAL INSERTS 10 MG,Rx55566280001,CDM,,,250,RC,55566-2800-01,NDC,,BOTH,10,ME,585.94,507.45,556.64,,,527.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.03,,,457.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.35,,,487.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.35,,,298.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.35,,,487.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.11,,,298.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,527.35,,,527.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.5,,,562.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,430.67,,,457.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,289.98,,,457.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,539.06,,,539.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.11,,,298.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,498.05,,,498.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.64,,,527.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.35,,,556.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,287.11,,,287.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,457.03,562.5,
HC GUIDE PIN 3.2MM X 330MM,Sx00S0100-000,CDM,,,270,RC,,,,BOTH,,,588,529.2,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,458.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,299.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.48,,,564.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.18,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.8,,,499.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,558.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,288.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,458.64,564.48,
HC SCREW TI 2.4X16MM VAL,SxAR-8724V-16,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,588,529.2,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,458.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,299.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.48,,,564.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.18,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.8,,,499.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,558.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,288.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,458.64,564.48,
HC SCREW STANDARD 3X14MM ANCHOR,Sx000PLSS3014,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,588,529.2,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,458.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,299.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,489.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.48,,,564.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.18,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,299.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.8,,,499.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558.6,,,529.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,558.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.12,,,288.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,458.64,564.48,
HC GRAFT CANCELLOUS CUBE 15CC BONE READIGRAFT ALLOGRAFT,SxCANCUBE15 S,CDM,C1762,HCPCS,278,RC,,,,BOTH,,,589.08,530.17,559.63,,,530.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459.48,,,459.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.17,,,490.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.17,,,300.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.17,,,490.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.65,,,300.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,530.17,,,530.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.52,,,565.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.97,,,459.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.54,,,459.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,541.95,,,541.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.65,,,300.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,500.72,,,500.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.63,,,530.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,530.17,,,559.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,288.65,,,288.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,459.48,565.52,
HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM,Px00045011004,CDM,96365,CPT,450,RC,,,,OUTPATIENT,,,590,419.4,560.5,,,461.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.2,,,400.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531,,,427.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531,,,261.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531,,,427.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.1,,,261.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,531,,,461.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,566.4,,,492.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,400.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,291.99,,,400.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,542.8,,,471.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.1,,,261.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,501.5,,,436.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.5,,,461.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531,,,487.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,289.1,,,289.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,460.2,566.4,
HC TROM ADVANCED POST OP BRACE KNEE UNIVERSAL COOL,Sx00042241700,CDM,L1832,HCPCS,274,RC,,,,BOTH,,,594.44,535,564.72,,,535,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.66,,,463.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535,,,494.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535,,,302.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535,,,494.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.28,,,302.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,535,,,535,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570.66,,,570.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.91,,,463.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.19,,,463.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.88,,,546.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.28,,,302.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,505.27,,,505.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.72,,,535,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535,,,564.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.28,,,291.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,463.66,570.66,
HC US TRANSVAGINAL NON-OB,Px00040210033,CDM,76830,CPT,402,RC,,,,BOTH,,,595,535.5,565.25,,,535.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.1,,,464.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,495.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,303.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,495.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.55,,,303.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,535.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.2,,,571.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,437.33,,,464.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,294.47,,,464.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,547.4,,,547.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.55,,,303.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,505.75,,,505.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.25,,,535.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,565.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,291.55,,,291.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,464.1,571.2,
HC BONE SCREW FULL THRD 2.7MM T10 L14MM,Sx00000657114,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,597,537.3,567.15,,,537.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.66,,,465.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.3,,,496.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.3,,,304.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.3,,,496.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.53,,,304.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,537.3,,,537.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.12,,,573.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.8,,,465.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,295.46,,,465.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,549.24,,,549.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.53,,,304.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.45,,,507.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.15,,,537.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,537.3,,,567.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,292.53,,,292.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,465.66,573.12,
HC APOLLO RF MP90 MULTI PORT ASPIRATING ABLATOR 90 DEG,Sx0000AR-9811,CDM,,,270,RC,,,,BOTH,,,598.5,538.65,568.58,,,538.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,466.83,,,466.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,498.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,305,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,498.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,305,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,538.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,574.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,439.9,,,466.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.2,,,466.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,550.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,305,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.73,,,508.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.58,,,538.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,568.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,293.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,466.83,574.56,
HC APOLLO RF XL90 EXTRA LARGE ASPIRATING ABLATOR 90 DEG,Sx0000AR-9821,CDM,,,270,RC,,,,BOTH,,,598.5,538.65,568.58,,,538.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,466.83,,,466.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,498.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,305,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,498.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,305,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,538.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,574.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,439.9,,,466.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.2,,,466.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,550.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,305,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.73,,,508.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.58,,,538.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.65,,,568.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,293.27,,,293.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,466.83,574.56,
HC ACP DOUBLE SYRINGE SYSTEM,Sx0ABS-10010S,CDM,,,270,RC,,,,BOTH,,,600,540,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576,,,576,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552,,,552,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510,,,510,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,570,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,294,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,468,576,
HC ANTERIOR CANNULA ZONE NAVIGATOR,Sx0000AR-7905,CDM,,,270,RC,,,,BOTH,,,600,540,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576,,,576,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552,,,552,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510,,,510,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,570,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,294,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,468,576,
HC SCREW LO-PRO LOCK TI 3.5X18MM,SxAR-8935L-18,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,600,540,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576,,,576,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552,,,552,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510,,,510,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,570,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,294,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,468,576,
HC SCREW LO-PRO LOCK TI 3.5X20MM,SxAR-8935L-20,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,600,540,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576,,,576,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552,,,552,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510,,,510,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,570,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,294,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,468,576,
HC US EXAM OF HEAD AND NECK,Px00040210004,CDM,76536,CPT,402,RC,,,,BOTH,,,600,540,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,468,,,468,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,305.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,499.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,540,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576,,,576,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,468,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552,,,552,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,305.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510,,,510,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570,,,540,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540,,,570,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,294,,,294,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,468,576,
HC PR 45381 COLONOSCOPY SUBMUCOUS INJ,Px00097510769,CDM,45381,CPT,975,RC,,,,BOTH,,,466,419.4,260.96,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.47,,,363.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,384.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,223.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.25,,,384.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,222.05,,,223.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.4,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.3,,,332.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,363.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,363.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.62,,,428.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.88,,,237.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.62,,,396.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.96,,,419.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.01,,,442.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,193.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,193.09,576.01,
HC PR 11606 EXC TR-EXT MLG+MARG > 4 CM,Px00097510458,CDM,11606,CPT,975,RC,,,,BOTH,,,740,666,414.4,,,666,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.77,,,577.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,462.5,,,615.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,462.5,,,377.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,462.5,,,615.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,353.87,,,377.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,381.8,,,666,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,407,,,710.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.71,,,577.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.71,,,577.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.8,,,680.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,316.94,,,377.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.8,,,629,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.4,,,666,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,576.01,,,703,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.71,,,307.71,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,307.71,576.01,
HC PR 27618 EXC LEG/ANKLE TUM < 3 CM,Px00097510953,CDM,27618,CPT,975,RC,,,,BOTH,,,1181,1062.9,661.36,,,1062.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,392.25,,,921.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,738.13,,,920.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,738.13,,,353.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,738.13,,,920.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.46,,,353.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.28,,,1062.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,649.55,,,413.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,305.42,,,921.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.42,,,921.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,673.17,,,1086.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.58,,,601.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,673.17,,,1003.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.36,,,1062.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,577.8,,,1121.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,305.42,,,305.42,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,305.42,577.8,
HC PR 27425 LATERAL RETINACULAR RELEASE OPEN,Px00097510633,CDM,27425,CPT,975,RC,,,,BOTH,,,1090,981,610.4,,,981,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,590.85,,,850.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.25,,,907.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.25,,,555.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.25,,,907.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,528.78,,,555.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,533.82,,,981,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,599.5,,,1046.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,850.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,850.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,621.3,,,1002.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,473.6,,,555.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,621.3,,,926.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,610.4,,,981,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.25,,,1035.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,401.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,401.36,578.25,
HC ED IV HYDRATION INITIAL HR CDM,Px00045011001,CDM,96360,CPT,450,RC,,,,OUTPATIENT,,,606,431.1,575.7,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.68,,,411.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,438.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,268.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,438.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,268.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.76,,,505.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.41,,,411.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.91,,,411.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,557.52,,,484.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,268.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.1,,,447.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,575.7,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,500.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,296.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,472.68,581.76,
HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM,Px00045011011,CDM,96374,CPT,450,RC,,,,OUTPATIENT,,,606,431.1,575.7,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,472.68,,,411.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,438.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,268.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,438.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,268.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.76,,,505.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,445.41,,,411.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,299.91,,,411.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,557.52,,,484.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,268.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.1,,,447.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,575.7,,,474.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.4,,,500.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,296.94,,,296.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,472.68,581.76,
HC PR 27687 REVISION OF CALF TENDON,Px00097512304,CDM,27687,CPT,975,RC,,,,BOTH,,,1091,981.9,610.96,,,981.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,583.86,,,850.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.88,,,900.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.88,,,524.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.88,,,900.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,522.93,,,524.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,539.93,,,981.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,600.05,,,617.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.75,,,850.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,465.75,,,850.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,621.87,,,1003.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.36,,,555.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,621.87,,,927.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,610.96,,,981.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,587.25,,,1036.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.75,,,465.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,465.75,587.25,
HC PR 27062 REMOVE FEMUR LESION/BURSA,Px00096910744,CDM,27062,CPT,983,RC,,,,BOTH,,,1082,973.8,605.92,,,973.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,590.44,,,843.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,676.25,,,894.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,676.25,,,526.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,676.25,,,894.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,523.81,,,526.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.55,,,973.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,615.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.36,,,843.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,358.36,,,843.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,616.74,,,995.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,469.15,,,551.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,616.74,,,919.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,605.92,,,973.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,589.5,,,1027.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,358.36,,,358.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,358.36,589.5,
HC DRILL BIT 2.7mm CMP FT CALIBRATED,Sx0AR-8737-35,CDM,,,270,RC,,,,BOTH,,,614.25,552.83,583.54,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.12,,,479.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,511.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,313.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,511.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,313.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.47,,,479.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.99,,,479.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.11,,,565.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,313.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.11,,,522.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.54,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,583.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,300.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.12,589.68,
HC FIBERTAK DISPOSABLES CURVED KT,Sx00AR-3638DC,CDM,,,270,RC,,,,BOTH,,,614.25,552.83,583.54,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.12,,,479.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,511.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,313.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,511.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,313.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.47,,,479.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.99,,,479.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.11,,,565.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,313.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.11,,,522.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.54,,,552.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.83,,,583.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,300.98,,,300.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.12,589.68,
HC ED CLOSED TX FINGER DISLOCATION W/O ANESTH CDM,Px00045010851,CDM,26770,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,435.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,435.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,344.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM,Px00045010579,CDM,23545,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT SHOULDER DISLOCATION W/MANIP CDM,Px00045010594,CDM,23650,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT ELBOW DISLOCATION W/O ANESTH CDM,Px00045010738,CDM,24600,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM,Px00045010749,CDM,24640,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT FRACTURE OF ULNA CDM,Px00045010790,CDM,25530,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM,Px00045010794,CDM,25535,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM,Px00045010900,CDM,26600,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED TREAT METACARPAL FRACTURE SINGLE W/MANIPULATION CDM,Px00045010904,CDM,26605,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER OR THUMB W/MANIP EA CDM,Px00045010943,CDM,26725,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC ED CLOSED TX HIP DISLOCATION W/O ANESTH CDM,Px00045010263,CDM,27250,CPT,450,RC,,,,OUTPATIENT,,,615,437.4,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,417.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,272.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,445.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,513.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,417.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,272.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,454.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,481.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,508.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC REAMER 5.1MM CANNULTD W/STOP,Sx0000AR-2374,CDM,,,270,RC,,,,BOTH,,,615,553.5,584.25,,,553.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.7,,,479.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,511.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,313.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,511.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,313.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,553.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.4,,,590.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.03,,,479.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,304.36,,,479.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.8,,,565.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,313.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.75,,,522.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.25,,,553.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.5,,,584.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,301.35,,,301.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,479.7,590.4,
HC TWIST DRILL 100 X 40MM STRYKER SHAFT,Sx00060-20185,CDM,,,270,RC,,,,BOTH,,,618,556.2,587.1,,,556.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.04,,,482.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.2,,,514.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.2,,,314.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.2,,,514.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.82,,,314.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.2,,,556.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.28,,,593.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,454.23,,,482.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,305.85,,,482.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,568.56,,,568.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.82,,,314.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,525.3,,,525.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.1,,,556.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,556.2,,,587.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,302.82,,,302.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,482.04,593.28,
METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML),Rx00517037405,CDM,Q9968,HCPCS,636,RC,517037405,NDC,,BOTH,10,ML,618.7,438.86,587.77,,,587.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,482.59,,,482.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,556.83,,,556.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,556.83,,,556.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,556.83,,,556.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.16,,,303.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,556.83,,,556.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,593.95,,,593.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,454.74,,,454.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,303.16,,,303.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,569.2,,,569.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.16,,,303.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,525.9,,,525.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,587.77,,,587.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,556.83,,,556.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,303.16,,,303.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,482.59,593.95,
HC ED TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM,Px00045010909,CDM,26641,CPT,450,RC,,,,OUTPATIENT,,,620,441,589,,,485.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.6,,,420.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,448.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,274.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,448.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,274.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,558,,,485.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.2,,,517.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.7,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,306.84,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,570.4,,,495.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,274.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,527,,,458.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589,,,485.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,512.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,303.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,483.6,595.2,
HC SPIROMETRY PRE POST BRONCHODILATOR,Px00046010063,CDM,94060,CPT,460,RC,,,,BOTH,,,620,558,589,,,558,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.6,,,483.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,495.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,495.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,558,,,558,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.2,,,595.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.7,,,483.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,483.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,570.4,,,570.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,315.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,527,,,527,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589,,,558,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,558,,,589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,303.8,,,303.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,483.6,595.2,
HC CATHETER BAKER JEJUNOSTOMY 16FR 108 IN L 15CC BALLOON 425,Sx00000042510,CDM,,,270,RC,,,,BOTH,,,622.92,560.63,591.77,,,560.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.88,,,485.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,518.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,317.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,518.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.23,,,317.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,560.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598,,,598,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.85,,,485.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.28,,,485.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,573.09,,,573.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.23,,,317.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.48,,,529.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.77,,,560.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.63,,,591.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.23,,,305.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,485.88,598,
HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM,Px00045010198,CDM,27786,CPT,450,RC,,,,OUTPATIENT,,,623,443.7,591.85,,,487.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.94,,,422.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.7,,,451.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.7,,,276.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.7,,,451.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.27,,,276.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.7,,,487.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.08,,,520.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.91,,,422.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.32,,,422.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,573.16,,,498.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.27,,,276.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,529.55,,,460.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.85,,,487.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,560.7,,,514.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.27,,,305.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,485.94,598.08,
HC PR 45380 COLONOSCOPY AND BIOPSY,Px00097510768,CDM,45380,CPT,975,RC,,,,BOTH,,,467,420.3,261.52,,,420.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.47,,,364.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.88,,,385.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.88,,,223.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,291.88,,,385.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,222.05,,,223.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.4,,,420.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,256.85,,,351.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,364.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,364.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.19,,,429.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.88,,,237.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,266.19,,,396.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,261.52,,,420.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,598.95,,,443.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.09,,,193.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,193.09,598.95,
HC DRILL SPEEDGUIDE 2.6MM L30MM,Sx00000703934,CDM,,,270,RC,,,,BOTH,,,624,561.6,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.72,,,486.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,317.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,599.04,,,599.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.82,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.08,,,574.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,530.4,,,530.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,592.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,305.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.72,599.04,
HC SCREW LOCKING 2.7 X 16MM IMPL,Sx00040-27616,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,624,561.6,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.72,,,486.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,317.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,599.04,,,599.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.82,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.08,,,574.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,530.4,,,530.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,592.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,305.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.72,599.04,
HC SCREW LOCKING 2.7 X 18MM IMPL,Sx00040-27618,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,624,561.6,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.72,,,486.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,317.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,599.04,,,599.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.82,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.08,,,574.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,530.4,,,530.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,592.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,305.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.72,599.04,
HC US OB >= 14 WKS SINGLE FETUS,Px00040210016,CDM,76805,CPT,402,RC,,,,BOTH,,,624,561.6,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486.72,,,486.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,317.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,519.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,599.04,,,599.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,458.64,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,308.82,,,486.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.08,,,574.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,317.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,530.4,,,530.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,592.8,,,561.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,561.6,,,592.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,305.76,,,305.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,486.72,599.04,
HC PR ED 27810 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM,Px00098110409,CDM,27810,CPT,981,RC,,,,OUTPATIENT,,,1018,916.2,570.08,,,916.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,552.68,,,794.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,636.25,,,847.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,636.25,,,518.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,636.25,,,847.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,500.88,,,518.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,501.02,,,916.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,559.9,,,977.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,794.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,794.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,580.26,,,936.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,448.62,,,518.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,580.26,,,865.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,570.08,,,916.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,599.39,,,967.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,435.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,435.55,599.39,
HC STAPLER CDH33 INTRALUMINAL PREMIUM PLUS TITANIUM 33MM,Sx000000CDH33,CDM,,,270,RC,,,,BOTH,,,625.05,562.55,593.8,,,562.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,487.54,,,487.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,520.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,318.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,520.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,318.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,562.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,600.05,,,600.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459.41,,,487.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.34,,,487.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,575.05,,,575.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,318.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,531.29,,,531.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.8,,,562.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,593.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,306.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,487.54,600.05,
HC STAPLER CDH25 INTRALUMINAL PREMIUM PLUS TITANIUM 25MM,Sx000000CDH25,CDM,,,270,RC,,,,BOTH,,,625.05,562.55,593.8,,,562.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,487.54,,,487.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,520.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,318.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,520.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,318.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,562.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,600.05,,,600.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,459.41,,,487.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.34,,,487.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,575.05,,,575.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,318.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,531.29,,,531.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.8,,,562.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.55,,,593.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,306.27,,,306.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,487.54,600.05,
HC CYSTOSTOMY TUBE CHANGE,Px00036110687,CDM,51705,CPT,761,RC,,,,BOTH,,,627,564.3,595.65,,,564.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,489.06,,,489.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,521.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,319.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,521.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.23,,,319.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,564.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.92,,,601.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,460.85,,,489.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,307.23,,,489.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,576.84,,,576.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.23,,,319.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,532.95,,,532.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.65,,,564.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,595.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,307.23,,,307.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,489.06,601.92,
HC PR 26045 RELEASE PALM CONTRACTURE,Px00097510922,CDM,26045,CPT,975,RC,,,,BOTH,,,1148,1033.2,642.88,,,1033.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.53,,,895.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,717.5,,,947.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,717.5,,,551.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,717.5,,,947.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.71,,,551.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,556.3,,,1033.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.4,,,630.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,895.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,895.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,654.36,,,1056.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,493.25,,,585.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,654.36,,,975.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,642.88,,,1033.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.45,,,1090.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,185.47,,,185.47,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,185.47,603.45,
HC ED INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE CDM,Px00045010066,CDM,31500,CPT,450,RC,,,,OUTPATIENT,,,630,448.2,598.5,,,493.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.4,,,427.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567,,,456.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567,,,279.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567,,,456.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,279.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,567,,,493.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.8,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,463.05,,,427.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,311.79,,,427.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,579.6,,,504.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,279.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,535.5,,,465.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.5,,,493.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567,,,520.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,308.7,,,308.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,491.4,604.8,
HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,Px00046010089,CDM,94726,CPT,460,RC,,,,BOTH,,,632,568.8,600.4,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,492.96,,,492.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,322.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.72,,,606.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.52,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,581.44,,,581.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,537.2,,,537.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,600.4,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,600.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,309.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,492.96,606.72,
HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,Px00046010008,CDM,94726,CPT,460,RC,,,,BOTH,,,632,568.8,600.4,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,492.96,,,492.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,322.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.72,,,606.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.52,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,581.44,,,581.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,537.2,,,537.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,600.4,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.8,,,600.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.68,,,309.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,492.96,606.72,
HC CARDIOPULMONARY RESUSCITATION,Px00041010007,CDM,92950,CPT,410,RC,,,,BOTH,,,632.57,569.31,600.94,,,569.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.4,,,493.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.31,,,526.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.31,,,322.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.31,,,526.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.96,,,322.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,569.31,,,569.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.27,,,607.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.94,,,493.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,313.06,,,493.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,581.96,,,581.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.96,,,322.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,537.68,,,537.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,600.94,,,569.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.31,,,600.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,309.96,,,309.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,493.4,607.27,
HC PR ED 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX FRHD CKS SHN CDM,Px00098110502,CDM,13132,CPT,981,RC,,,,OUTPATIENT,,,702,631.8,393.12,,,631.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,385.95,,,547.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,584.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,357.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.75,,,584.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,339.78,,,357.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,376.02,,,631.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,386.1,,,673.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,295.46,,,547.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,295.46,,,547.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.14,,,645.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.32,,,357.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.14,,,596.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.12,,,631.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,607.5,,,666.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,295.46,,,295.46,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,295.46,607.5,
HC BONE SCREW T10 FULL THREAD 3.5MM / L20MM,Sx00000657420,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,633,569.7,601.35,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.74,,,493.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,526.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,322.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,526.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,322.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.68,,,607.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.26,,,493.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,313.27,,,493.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,582.36,,,582.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,322.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.05,,,538.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.35,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,601.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,310.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,493.74,607.68,
HC BONE SCREW T10 FULL THREAD 3.5MM / L28MM,Sx00000657428,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,633,569.7,601.35,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.74,,,493.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,526.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,322.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,526.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,322.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.68,,,607.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.26,,,493.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,313.27,,,493.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,582.36,,,582.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,322.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,538.05,,,538.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.35,,,569.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.7,,,601.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,310.17,,,310.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,493.74,607.68,
HC PR 21931 EXC BACK LES SC 3+ CM,Px00097510411,CDM,21931,CPT,975,RC,,,,BOTH,,,1118,1006.2,626.08,,,1006.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,595.06,,,872.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,698.75,,,846.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,698.75,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,698.75,,,846.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,506.38,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,559.43,,,1006.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,614.9,,,633.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.18,,,872.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,362.18,,,872.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,637.26,,,1028.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,477.41,,,569.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,637.26,,,950.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,626.08,,,1006.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,1062.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,362.18,,,362.18,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,362.18,610.2,
"HC PR 29805 SHLDR ARTHROSCOP,DIAGNOSTIC [29805] CDM",Px00098300180,CDM,29805,CPT,975,RC,,,,BOTH,,,157,141.3,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,609.72,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,130.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,80.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,98.13,,,130.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.77,,,80.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,562.77,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.35,,,150.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,122.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,122.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,144.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,486.13,,,80.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.49,,,133.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,87.92,,,141.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,149.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,611.1,
HC DRILL BIT 3MM CALIBRATE REAMER,Sx00XFO013002,CDM,,,270,RC,,,,BOTH,,,638.4,574.56,606.48,,,574.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.95,,,497.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,531.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,325.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,531.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.82,,,325.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,574.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,612.86,,,612.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,469.22,,,497.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,315.94,,,497.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.33,,,587.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.82,,,325.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,542.64,,,542.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.48,,,574.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.56,,,606.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,312.82,,,312.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,497.95,612.86,
HC PR 25075 EXC FOREARM LES SC < 3 CM,Px00097510908,CDM,25075,CPT,975,RC,,,,BOTH,,,750,675,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,408.04,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,620.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,365.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,620.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,365.27,,,365.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,377.35,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.5,,,426.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,690,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.16,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,637.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,613.8,,,712.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.63,,,317.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,317.63,613.8,
HC ED DRAINAGE OF TONSIL ABSCESS CDM,Px00045013232,CDM,42700,CPT,450,RC,,,,OUTPATIENT,,,641,455.4,608.95,,,501.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.98,,,434.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576.9,,,463.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576.9,,,283.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576.9,,,463.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.09,,,283.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,576.9,,,501.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.36,,,534.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.14,,,434.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.23,,,434.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.72,,,512.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.09,,,283.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,544.85,,,473.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.95,,,501.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,576.9,,,529.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.09,,,314.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,499.98,615.36,
HC STAPLER PROX ACESS 55GRE SINGLE USE DISP RELOADABLE,Sx000000AX55G,CDM,,,270,RC,,,,BOTH,,,641.13,577.02,609.07,,,577.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.08,,,500.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,577.02,,,533.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,577.02,,,326.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,577.02,,,533.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.15,,,326.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,577.02,,,577.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.48,,,615.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,471.23,,,500.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.3,,,500.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.84,,,589.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.15,,,326.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,544.96,,,544.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,609.07,,,577.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,577.02,,,609.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,314.15,,,314.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,500.08,615.48,
HC PR 46260 REMOVE INTERNAL/EXTERNAL HEMORROID GROUPS 2+,Px00097510791,CDM,46260,CPT,975,RC,,,,BOTH,,,1149,1034.1,643.44,,,1034.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,672.92,,,896.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,718.13,,,868.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,718.13,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,718.13,,,868.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,548.19,,,234.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,568.46,,,1034.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.95,,,641.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.94,,,896.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,350.94,,,896.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,654.93,,,1057.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.99,,,585.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,654.93,,,976.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,643.44,,,1034.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,617.39,,,1091.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.94,,,350.94,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,350.94,617.39,
HC HEADED REAMER 7MM CANNULATED,Sx0000AR-1407,CDM,,,270,RC,,,,BOTH,,,645,580.5,612.75,,,580.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,503.1,,,503.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.5,,,536.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.5,,,328.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.5,,,536.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.05,,,328.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,580.5,,,580.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,619.2,,,619.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.08,,,503.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,319.21,,,503.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.4,,,593.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.05,,,328.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,548.25,,,548.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,612.75,,,580.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.5,,,612.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.05,,,316.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,503.1,619.2,
HC ED RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX CDM,Px00045013226,CDM,41252,CPT,450,RC,,,,OUTPATIENT,,,646,459.9,613.7,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,503.88,,,438.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,286.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,539.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.81,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,319.71,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.32,,,517.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,549.1,,,477.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.7,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,533.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,316.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,503.88,620.16,
HC ED DRAINAGE MOUTH ROOF LESION CDM,Px00045013229,CDM,42000,CPT,450,RC,,,,OUTPATIENT,,,646,459.9,613.7,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,503.88,,,438.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,286.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,467.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,539.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.81,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,319.71,,,438.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.32,,,517.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,286.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,549.1,,,477.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.7,,,505.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.4,,,533.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,316.54,,,316.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,503.88,620.16,
HC PR ED 27818 CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM,Px00098110413,CDM,27818,CPT,981,RC,,,,OUTPATIENT,,,1046,941.4,585.76,,,941.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,565.45,,,815.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,653.75,,,870.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,653.75,,,533.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,653.75,,,870.69,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,514.43,,,533.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,514.08,,,941.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,575.3,,,1004.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,447.33,,,815.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,447.33,,,815.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,596.22,,,962.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,460.75,,,533.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,596.22,,,889.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,585.76,,,941.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,621.45,,,993.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,447.33,,,447.33,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,447.33,621.45,
HC LOCKING SCREW 4.0 X L26MM SELF TAP,Sx00000661026,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,650.7,585.63,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.55,,,507.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,331.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,585.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.67,,,624.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.26,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.03,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.64,,,598.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.1,,,553.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,618.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,318.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,507.55,624.67,
HC LOCKING SCREW 4.0 X L38MM SELF TAP,Sx00000661038,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,650.7,585.63,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.55,,,507.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,331.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,585.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.67,,,624.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.26,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.03,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.64,,,598.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.1,,,553.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,618.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,318.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,507.55,624.67,
HC LOCKING SCREW 4.0 X L44MM SELF TAP,Sx00000661044,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,650.7,585.63,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.55,,,507.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,331.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,585.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.67,,,624.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.26,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.03,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.64,,,598.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.1,,,553.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,618.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,318.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,507.55,624.67,
HC LOCKING SCREW 4.0 X L46MM SELF TAP,Sx00000661046,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,650.7,585.63,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.55,,,507.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,331.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,541.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,585.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.67,,,624.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,478.26,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.03,,,507.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.64,,,598.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,331.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,553.1,,,553.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.17,,,585.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.63,,,618.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,318.84,,,318.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,507.55,624.67,
HC DRILL BIT 2.0 X 150MM,Sx00000072453,CDM,,,270,RC,,,,BOTH,,,652.8,587.52,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.18,,,509.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.69,,,626.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.81,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.07,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.58,,,600.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,554.88,,,554.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,620.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,319.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,509.18,626.69,
HC SCREW CANNULATED 4X50MM Ti ASNIS III EXPLANT,Sx0000604650S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,652.8,587.52,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.18,,,509.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.69,,,626.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.81,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.07,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.58,,,600.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,554.88,,,554.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,620.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,319.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,509.18,626.69,
HC SCREW CANNULATED 4X50MM Ti ASNIS III IMPLANT,Sx0000604650S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,652.8,587.52,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.18,,,509.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.69,,,626.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.81,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.07,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.58,,,600.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,554.88,,,554.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,620.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,319.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,509.18,626.69,
HC SCREW CANNULATED 4X50MM THREAD Ti ASNIS III EXPLANT,Sx0000604750S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,652.8,587.52,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.18,,,509.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,543.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.69,,,626.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.81,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.07,,,509.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.58,,,600.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,332.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,554.88,,,554.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.16,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,620.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,319.87,,,319.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,509.18,626.69,
HC LOCKING SCREW T8 FULL THREAD 2.4MM L22MM,Sx00000656022,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,653.16,587.84,620.5,,,587.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.46,,,509.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.84,,,543.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.84,,,332.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.84,,,543.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.05,,,332.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.84,,,587.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.03,,,627.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,480.07,,,509.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.25,,,509.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.91,,,600.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.05,,,332.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,555.19,,,555.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.5,,,587.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,587.84,,,620.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,320.05,,,320.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,509.46,627.03,
HC PR ED 25535 TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM,Px00098110736,CDM,25535,CPT,981,RC,,,,OUTPATIENT,,,1094,984.6,612.64,,,984.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,599.86,,,853.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,683.75,,,910.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,683.75,,,557.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,683.75,,,910.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,537.08,,,557.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,534.76,,,984.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,601.7,,,1050.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,853.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,853.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,623.58,,,1006.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.04,,,557.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,623.58,,,929.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,612.64,,,984.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,627.3,,,1039.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,467.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,467.03,627.3,
"HC PR 45385 LESION REMOVAL COLONOSCOPY, POLYP SNARE",Px00097510773,CDM,45385,CPT,975,RC,,,,BOTH,,,592,532.8,331.52,,,532.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,344.06,,,461.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370,,,488.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370,,,282.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370,,,488.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,279.99,,,282.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,309.28,,,532.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,325.6,,,417.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.47,,,461.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,243.47,,,461.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.44,,,544.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,250.77,,,301.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.44,,,503.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.52,,,532.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,628.2,,,562.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,243.47,,,243.47,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,243.47,628.2,
HC SCREW LOCKING T10 3.5X14MM IMP,Sx00040-35614,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC SCREW LOCKING T10 3.5X16MM IMP,Sx00040-35616,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC SCREW LOCKING T10 3.5X18MM IMP,Sx00040-35618,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC SCREW LOCKING 2.7 X 10MM IMP,Sx00040-27610,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC SCREW LOCKING 2.7 X 12MM IMP,Sx00040-27612,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC SCREW LOCKING T10 3.5X20MM,Sx00040-35620,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,655.2,589.68,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.06,,,511.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,545.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.99,,,628.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,481.57,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324.26,,,511.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.78,,,602.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,333.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,556.92,,,556.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.44,,,589.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.68,,,622.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,321.05,,,321.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,511.06,628.99,
HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,Px00092110020,CDM,93979,CPT,921,RC,,,,BOTH,,,659,593.1,626.05,,,593.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.02,,,514.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.1,,,548.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.1,,,335.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.1,,,548.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.45,,,335.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.1,,,593.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.64,,,632.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,484.37,,,514.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.91,,,514.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,606.28,,,606.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.09,,,335.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.15,,,560.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.05,,,593.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.1,,,626.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,322.91,,,322.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.02,632.64,
HC COLD THERAPY POLAR ACTIVE ICE 3.0 SHOULDER & UPPER ARM,SxAIS3.0-9-SB,CDM,,,270,RC,,,,BOTH,,,659.97,593.97,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.78,,,514.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,336.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,633.57,,,633.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.08,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.62,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.17,,,607.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.97,,,560.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,626.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,323.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.78,633.57,
HC COLD THERAPY POLAR ACTIVE ICE 3.0 KNEE & JOINT,SxAIS3.0-9-KB,CDM,,,270,RC,,,,BOTH,,,659.97,593.97,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.78,,,514.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,336.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,633.57,,,633.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.08,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.62,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.17,,,607.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.97,,,560.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,626.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,323.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.78,633.57,
HC COLD THERAPY POLAR ACTIVE ICE 3.0 BACK & HIP,SxAIS3.0-9-LB,CDM,,,270,RC,,,,BOTH,,,659.97,593.97,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.78,,,514.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,336.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,549.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,633.57,,,633.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.08,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,326.62,,,514.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.17,,,607.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,336.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,560.97,,,560.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.97,,,593.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,593.97,,,626.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.39,,,323.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.78,633.57,
HC L&D TRIAGE NEW PATIENT LVL 3 CDM,Px00076100003,CDM,99203,CPT,761,RC,,,,BOTH,,,660,495,627,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.8,,,514.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,523.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,523.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,633.6,,,102.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.1,,,514.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,514.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.2,,,607.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,336.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561,,,561,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,627,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,323.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.8,633.6,
HC L&D TRIAGE ESTAB PATIENT LVL 4 CDM,Px00076110534,CDM,99214,CPT,761,RC,,,,BOTH,,,660,495,627,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.8,,,514.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,523.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,523.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,633.6,,,104.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.1,,,514.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,514.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.2,,,607.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,336.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,561,,,561,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627,,,594,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594,,,627,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,323.4,,,323.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,514.8,633.6,
METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),Rx65649055103,CDM,J2212,HCPCS,636,RC,65649055103,NDC,,BOTH,0.6,ML,661.22,571.55,628.16,,,595.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.75,,,515.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,550.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,337.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,550.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,337.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,595.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.77,,,634.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,486,,,515.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,324,,,515.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,608.32,,,608.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,337.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,562.04,,,562.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.16,,,595.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.1,,,628.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,324,,,324,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,515.75,634.77,
HC PR 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION  CDM,Px00097514022,CDM,19120,CPT,975,RC,,,,BOTH,,,478,430.2,267.68,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,532.72,,,372.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,397.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.75,,,397.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,473.5,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,490.92,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,262.9,,,458.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.74,,,372.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,411.74,,,372.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.46,,,439.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,424.09,,,243.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.46,,,406.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.68,,,430.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,634.95,,,454.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,411.74,,,411.74,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,411.74,634.95,
HC PR 43251 EGD REMOVE LESION SNARE,Px00097510505,CDM,43251,CPT,975,RC,,,,BOTH,,,474,426.6,265.44,,,426.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.82,,,369.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.25,,,388.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.25,,,218.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,296.25,,,388.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.33,,,218.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,239.03,,,426.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.7,,,286.43,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.11,,,369.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,188.11,,,369.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,270.18,,,436.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,193.75,,,241.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,270.18,,,402.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,265.44,,,426.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,637.2,,,450.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,188.11,,,188.11,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,188.11,637.2,
HC SCREW LOCKING 3.5 X 10MM IMP,Sx000PLSL3512,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC SCREW LOCKING 3.5 X 14MM IMPL,Sx000PLSL3514,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC SCREW LOCKING 3.5 X 18MM IMPL,Sx000PLSL3518,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC SCREW LOCKING 3.5 X 20MM IMPL,Sx000PLSL3520,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC SCREW LOCKING 3 X 12MM ANCHOR,Sx000PLSL3012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC SCREW LOCKING 3 X 18MM ANCHOR,Sx000PLSL3018,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,664.8,598.32,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.54,,,518.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,338.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,553.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.21,,,638.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.63,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,329.01,,,518.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.62,,,611.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,338.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.08,,,565.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.56,,,598.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.32,,,631.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,325.75,,,325.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,518.54,638.21,
HC PR 28270 RELEASE OF FOOT CONTRACTURE,Px00097512340,CDM,28270,CPT,975,RC,,,,BOTH,,,1157,1041.3,647.92,,,1041.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.83,,,902.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,723.13,,,963.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,723.13,,,589.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,723.13,,,963.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,385.69,,,589.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,400.54,,,1041.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,636.35,,,1110.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.38,,,902.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.38,,,902.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,659.49,,,1064.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,345.44,,,589.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,659.49,,,983.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,647.92,,,1041.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,638.55,,,1099.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.38,,,335.38,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,335.38,638.55,
HC TWIST DRILL 3.5MM 195MM AO FIT,Sx00000700353,CDM,,,270,RC,,,,BOTH,,,668.58,601.72,635.15,,,601.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.49,,,521.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,556.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,340.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,556.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,340.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,601.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,641.84,,,641.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,491.41,,,521.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,330.88,,,521.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,615.09,,,615.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,340.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,568.29,,,568.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.15,,,601.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,635.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,327.6,,,327.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,521.49,641.84,
HC CRE BALLOON DILATOR 18-19-20 DISP WITH 3 SIZE RANGES,Sx00M00558500,CDM,,,270,RC,,,,BOTH,,,674.58,607.12,640.85,,,607.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,526.17,,,526.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.12,,,561.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.12,,,343.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.12,,,561.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.54,,,343.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,607.12,,,607.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,647.6,,,647.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,495.82,,,526.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,333.85,,,526.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,620.61,,,620.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.54,,,343.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,573.39,,,573.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,640.85,,,607.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.12,,,640.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,330.54,,,330.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,526.17,647.6,
HC RBC LEUKORED IRRAD CMV NEG EA,Px00039010044,CDM,P9058,CPT,390,RC,,,,BOTH,,,678,610.2,644.1,,,610.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,528.84,,,528.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,564.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,345.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,564.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,332.22,,,345.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,610.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,650.88,,,650.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,498.33,,,528.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.54,,,528.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.76,,,623.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,332.22,,,345.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,576.3,,,576.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,644.1,,,610.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.2,,,644.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,332.22,,,332.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,528.84,650.88,
HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,Px00092110016,CDM,93971,CPT,921,RC,,,,BOTH,,,679,611.1,645.05,,,611.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.62,,,529.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,565.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,346.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,565.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,349.75,,,346.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,611.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,651.84,,,651.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,499.07,,,529.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,332.71,,,529.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,624.68,,,624.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,346.29,,,346.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,577.15,,,577.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.05,,,611.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.1,,,645.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,332.71,,,332.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,529.62,651.84,
ACETYLCYSTEINE INJ 200 MG/ML,Rx63323096330,CDM,J0132,HCPCS,636,RC,63323096330,NDC,,BOTH,1,ML,680.6,612.9,646.57,,,646.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,530.87,,,530.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,612.54,,,612.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,612.54,,,612.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,612.54,,,612.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.49,,,333.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,612.54,,,612.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,653.38,,,653.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,500.24,,,500.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,333.49,,,333.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,626.15,,,626.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.49,,,333.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,578.51,,,578.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,646.57,,,646.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,612.54,,,612.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.49,,,333.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,530.87,653.38,
ACETYLCYSTEINE INJ 200 MG/ML,Rx63323096321,CDM,J0132,HCPCS,636,RC,63323096321,NDC,,BOTH,1,ML,681.21,613.09,647.15,,,647.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,531.34,,,531.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,613.09,,,613.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,613.09,,,613.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,613.09,,,613.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.79,,,333.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,613.09,,,613.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,653.96,,,653.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,500.69,,,500.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,333.79,,,333.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,626.71,,,626.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.79,,,333.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,579.03,,,579.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,647.15,,,647.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,613.09,,,613.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,333.79,,,333.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,531.34,653.96,
HC GUIDE WIRE BALL TIP 3.0X800mm STERILE,Sx01806-0080S,CDM,,,270,RC,,,,BOTH,,,681.51,613.36,647.43,,,613.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531.58,,,531.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.36,,,567.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.36,,,347.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.36,,,567.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333.94,,,347.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,613.36,,,613.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.25,,,654.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.91,,,531.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,337.28,,,531.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,626.99,,,626.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333.94,,,347.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,579.28,,,579.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,647.43,,,613.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.36,,,647.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,333.94,,,333.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,531.58,654.25,
EVOLOCUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 140 MG/ML,Rx72511075001,CDM,C9399,HCPCS,636,RC,72511075001,NDC,,BOTH,1,ML,681.92,602.16,647.82,,,613.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,531.9,,,532.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.73,,,567.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.73,,,347.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.73,,,567.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.14,,,347.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,613.73,,,613.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.64,,,654.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,501.21,,,532.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,334.14,,,532.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,627.37,,,627.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.14,,,347.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,579.63,,,579.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,647.82,,,613.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,613.73,,,647.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,334.14,,,334.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,531.9,654.64,
HC PR 46270 REMOVE ANAL FIST SUBQ,Px00097510794,CDM,46270,CPT,975,RC,,,,BOTH,,,906,815.4,507.36,,,815.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,564,,,706.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.25,,,753.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.25,,,460.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.25,,,753.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,461.25,,,460.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.45,,,815.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.3,,,529.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.09,,,706.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.09,,,706.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,516.42,,,833.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,413.12,,,461.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,516.42,,,770.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.36,,,815.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,654.75,,,860.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.09,,,401.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,401.09,654.75,
HC PR 45384 LESION REMOVE COLONOSCOPY,Px00097510772,CDM,45384,CPT,975,RC,,,,BOTH,,,534,480.6,299.04,,,480.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.54,,,416.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,333.75,,,439.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,333.75,,,253.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,333.75,,,439.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,251.36,,,253.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,277.13,,,480.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.7,,,367.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.57,,,416.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,218.57,,,416.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.38,,,491.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.13,,,272.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,304.38,,,453.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,299.04,,,480.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,657.45,,,507.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,218.57,,,218.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,218.57,657.45,
HC PR 19285 PERQ DEV LOC BREAST 1ST US IMAG,Px00096910597,CDM,19285,CPT,975,RC,,,,BOTH,,,917,825.3,513.52,,,825.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,105.96,,,715.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,573.13,,,669.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,573.13,,,93.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,573.13,,,669.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,92.45,,,93.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,103.42,,,825.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,504.35,,,880.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.39,,,715.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,80.39,,,715.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,522.69,,,843.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.8,,,93.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,522.69,,,779.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,513.52,,,825.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,657.9,,,871.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.39,,,80.39,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,80.39,657.9,
HC PR 11646 EXC FACE-MM MLG+MARG > 4 CM,Px00097510092,CDM,11646,CPT,975,RC,,,,BOTH,,,914,822.6,511.84,,,822.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,495.17,,,712.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.25,,,760.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.25,,,465.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.25,,,760.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.06,,,465.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.47,,,822.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,502.7,,,877.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.31,,,712.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,378.31,,,712.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,520.98,,,840.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,389.66,,,465.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,520.98,,,776.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,511.84,,,822.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,659.25,,,868.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.31,,,378.31,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,378.31,659.25,
HC BRACE ALLIGN TLSO,Px00021163WNH,CDM,,,270,RC,,,,BOTH,,,687,618.3,652.65,,,618.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.86,,,535.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.3,,,571.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.3,,,350.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.3,,,571.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.63,,,350.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,618.3,,,618.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,659.52,,,659.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,504.95,,,535.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340,,,535.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,632.04,,,632.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.63,,,350.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,583.95,,,583.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,652.65,,,618.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,618.3,,,652.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,336.63,,,336.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,535.86,659.52,
GLUCAGON (RDNA) FOR INJ KIT 1 MG,Rx00002803101,CDM,J1610,HCPCS,636,RC,2803101,NDC,,BOTH,1,ME,687.48,618.73,653.11,,,653.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,536.23,,,536.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,618.73,,,618.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,618.73,,,618.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,618.73,,,618.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,336.87,,,336.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,618.73,,,618.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,659.98,,,659.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,505.3,,,505.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,336.87,,,336.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,632.48,,,632.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,336.87,,,336.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,584.36,,,584.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,653.11,,,653.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,618.73,,,618.73,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,336.87,,,336.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,536.23,659.98,
HC DRILL BIT 3.2MMX30MM RINGLOC+ ACET,Sx0031-323230,CDM,,,270,RC,,,,BOTH,,,690,621,655.5,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,574.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,351.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,574.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,351.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,621,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,662.4,,,662.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,538.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.48,,,538.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,634.8,,,634.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,351.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,586.5,,,586.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.5,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,655.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,338.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,538.2,662.4,
HC DRILL BIT 3.2MMX40MM RINGLOC+ ACET,Sx0031-323240,CDM,,,270,RC,,,,BOTH,,,690,621,655.5,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.2,,,538.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,574.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,351.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,574.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,351.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,621,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,662.4,,,662.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,538.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,341.48,,,538.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,634.8,,,634.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,351.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,586.5,,,586.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.5,,,621,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,621,,,655.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.1,,,338.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,538.2,662.4,
HC SCREW CANNULATED 4X40MM EXPL TI,Sx00000604640,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,691.2,622.08,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.14,,,539.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,352.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.55,,,663.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.03,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342.07,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.9,,,635.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,656.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,338.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,539.14,663.55,
HC SCREW CANNULATED 4X46MM IMPL TI,Sx00000604646,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,691.2,622.08,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.14,,,539.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,352.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.55,,,663.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.03,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342.07,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.9,,,635.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,656.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,338.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,539.14,663.55,
HC CANNULATED SCREW TI 4.0 X 38MM,Sx00000604638,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,691.2,622.08,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.14,,,539.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,352.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,575.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.55,,,663.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.03,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342.07,,,539.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.9,,,635.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,352.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.52,,,587.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.64,,,622.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.08,,,656.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,338.69,,,338.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,539.14,663.55,
HC PR ED 33016 PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM,Px00098110030,CDM,33016,CPT,981,RC,,,,OUTPATIENT,,,556,500.4,311.36,,,500.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.92,,,433.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,347.5,,,462.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,347.5,,,283.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,347.5,,,462.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.91,,,283.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,281.47,,,500.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,305.8,,,533.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.44,,,433.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,416.44,,,433.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,316.92,,,511.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.93,,,283.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,316.92,,,472.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,311.36,,,500.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,664.65,,,528.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.44,,,416.44,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,416.44,664.65,
HC AIRWAY LMA CLASSIC NO 4 REUSABLE TO 40 TIMES,Sx00000010140,CDM,,,270,RC,,,,BOTH,,,693,623.7,658.35,,,623.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.54,,,540.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,623.7,,,576.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,623.7,,,353.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,623.7,,,576.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,353.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.7,,,623.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.28,,,665.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.36,,,540.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,342.97,,,540.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,637.56,,,637.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,353.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.05,,,589.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,658.35,,,623.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,623.7,,,658.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,339.57,,,339.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,540.54,665.28,
HC PR ED 25565 TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM,Px00098110740,CDM,25565,CPT,981,RC,,,,OUTPATIENT,,,1877,1689.3,1051.12,,,1689.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.84,,,1464.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1173.13,,,1562.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1173.13,,,956.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1173.13,,,1562.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,542.69,,,956.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,552.8,,,1689.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1032.35,,,1801.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,471.9,,,1464.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,471.9,,,1464.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1069.89,,,1726.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,486.06,,,956.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1069.89,,,1595.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1051.12,,,1689.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,665.99,,,1783.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,471.9,,,471.9,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,471.9,665.99,
HC RBC LEUKOREDUCED IRRADIATED,Px00039010055,CDM,P9040,CPT,390,RC,,,,BOTH,,,694,610.2,659.3,,,624.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.32,,,541.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.6,,,577.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.6,,,353.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.6,,,577.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.06,,,353.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,624.6,,,624.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,666.24,,,666.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.09,,,541.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,343.46,,,541.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,638.48,,,638.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.06,,,353.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,589.9,,,589.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,659.3,,,624.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.6,,,659.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.06,,,340.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,541.32,666.24,
HC INTRA ACUITY PER HR CLASS 1,Px00072010068,CDM,,,720,RC,,,,BOTH,,,695,432.9,660.25,,,519.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,542.1,,,450.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.5,,,480.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.5,,,294.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.5,,,480.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.55,,,294.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,625.5,,,519.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.2,,,553.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.83,,,450.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,340.55,,,450.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.4,,,530.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.55,,,294.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,590.75,,,490.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.25,,,519.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.5,,,548.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.55,,,340.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,542.1,667.2,
HC PROBE FIAPC 7FR CIRCUMFERENTIAL,Sx0020132-218,CDM,,,270,RC,,,,BOTH,,,695.1,625.59,660.35,,,625.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,542.18,,,542.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.59,,,578.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.59,,,354.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.59,,,578.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.6,,,354.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,625.59,,,625.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.3,,,667.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.9,,,542.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,344,,,542.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.49,,,639.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.6,,,354.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,590.84,,,590.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.35,,,625.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.59,,,660.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,340.6,,,340.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,542.18,667.3,
HC GUIDE WIRE 1.4X150MM UNTHREAD,Sx00000705233,CDM,C1769,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC LOCKING SCREW T7 2.7X14MM,Sx0053-27614E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC LOCKING SCREW T7 2.7X18MM,Sx0053-27618E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC LOCKING SCREW T7 2.7X20MM,Sx0053-27620E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC LOCKING SCREW T7 2.7X22MM,Sx0053-27622E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC LOCKING SCREW T7 2.7X16MM,Sx0053-27616E,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,699,629.1,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.22,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.04,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,513.77,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.08,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.15,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,664.05,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,629.1,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,342.51,,,342.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,545.22,671.04,
HC CT ABDOMEN WO CONTRAST,Px00035210038,CDM,74150,CPT,350,RC,,,,BOTH,,,701,630.9,665.95,,,630.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,546.78,,,546.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,583.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,357.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,583.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.49,,,357.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,630.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,672.96,,,672.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.24,,,546.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,346.92,,,546.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,644.92,,,644.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.49,,,357.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,595.85,,,595.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.95,,,630.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,665.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.49,,,343.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,546.78,672.96,
EPOETIN ALFA INJ 20000 UNIT/ML,Rx59676032004,CDM,J0885,HCPCS,636,RC,59676032004,NDC,,BOTH,1,ML,701.07,631.45,666.02,,,631.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,546.83,,,546.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.96,,,583.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.96,,,357.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.96,,,583.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.52,,,357.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,630.96,,,631.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,673.03,,,673.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,515.29,,,546.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,343.52,,,546.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,644.98,,,645.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.52,,,357.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,595.91,,,596.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,666.02,,,631.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.96,,,666.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,343.52,,,343.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,546.83,673.03,
HC PR 24358 REPAIR ELBOW W/DEB OPEN,Px00096910703,CDM,24358,CPT,983,RC,,,,BOTH,,,1252,1126.8,701.12,,,1126.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,685.19,,,976.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,782.5,,,1042.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,782.5,,,638.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,782.5,,,1042.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.77,,,638.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,622.86,,,1126.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,688.6,,,1201.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,976.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,976.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,713.64,,,1151.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,551.51,,,638.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,713.64,,,1064.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,701.12,,,1126.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,673.2,,,1189.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,63.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,63.88,673.2,
HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML,Rx43528000301,CDM,90739,CPT,636,RC,43528000301,NDC,,BOTH,0.5,ML,701.54,631.39,666.46,,,666.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,547.2,,,547.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,631.39,,,631.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,631.39,,,631.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,631.39,,,631.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,343.75,,,343.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,631.39,,,631.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,673.48,,,673.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,515.63,,,515.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,343.75,,,343.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,645.42,,,645.42,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,343.75,,,343.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,596.31,,,596.31,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,666.46,,,666.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,631.39,,,631.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,343.75,,,343.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,547.2,673.48,
HC LOCKING SCREW T10 3.5X14MM,Sx00000614614,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,702.48,632.23,667.36,,,632.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,547.93,,,547.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.23,,,584.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.23,,,357.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.23,,,584.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,357.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,632.23,,,632.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.38,,,674.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,516.32,,,547.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,347.66,,,547.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,646.28,,,646.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,357.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,597.11,,,597.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.36,,,632.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.23,,,667.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,344.22,,,344.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,547.93,674.38,
HC APOLLO RF I90 ASPIRATING ABLATOR 90 DEG,Sx0000AR-9831,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,705,634.5,669.75,,,634.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,549.9,,,549.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.5,,,586.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.5,,,359.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.5,,,586.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.45,,,359.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,634.5,,,634.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.8,,,676.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.18,,,549.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,348.9,,,549.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,648.6,,,648.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.45,,,359.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,599.25,,,599.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.75,,,634.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.5,,,669.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.45,,,345.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,549.9,676.8,
HC TIGHTROPE ABS BUTTON ROUND 14MM CONCAVE,SxAR-1588TB-4,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,705.6,635.04,670.32,,,635.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.37,,,550.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.04,,,587.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.04,,,359.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.04,,,587.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.74,,,359.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.04,,,635.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.38,,,677.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.62,,,550.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.2,,,550.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.15,,,649.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.74,,,359.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,599.76,,,599.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.32,,,635.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.04,,,670.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.74,,,345.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.37,677.38,
HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM,Px00045010804,CDM,25600,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED TREAT KNUCKLE DISLOCATION W/O ANESTH CDM,Px00045010926,CDM,26700,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM,Px00045010165,CDM,27560,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM,Px00045013021,CDM,27840,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED TREAT BIG TOE FRACTURE W/MANIPULATION CDM,Px00045013069,CDM,28495,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ CDM,Px00045013076,CDM,28515,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC ED FAC E&M VISIT LEVEL 3 CDM,Px00045010210,CDM,99283,CPT,450,RC,,,,OUTPATIENT,,,706,502.2,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.68,,,478.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,312.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,511.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.76,,,589.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,518.91,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,349.4,,,478.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,649.52,,,564.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,312.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,600.1,,,521.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,670.7,,,552.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.4,,,583.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,345.94,,,345.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,550.68,677.76,
HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE,Px00097510130,CDM,49505,CPT,975,RC,,,,BOTH,,,1246,1121.4,697.76,,,1121.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,716.31,,,971.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.75,,,1026.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.75,,,591.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.75,,,1026.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,589.34,,,591.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,619.38,,,1121.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,685.3,,,701.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,971.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,971.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,710.22,,,1146.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,527.84,,,634.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,710.22,,,1059.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,697.76,,,1121.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,678.15,,,1183.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,678.15,
EPOETIN ALFA INJ 20000 UNIT/ML,Rx59676032000,CDM,J0885,HCPCS,636,RC,59676032000,NDC,,BOTH,1,ML,708.95,638.06,673.5,,,673.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,552.98,,,552.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,638.06,,,638.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,638.06,,,638.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,638.06,,,638.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,347.39,,,347.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,638.06,,,638.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,680.59,,,680.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,521.08,,,521.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,347.39,,,347.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,652.23,,,652.23,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,347.39,,,347.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,602.61,,,602.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,673.5,,,673.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,638.06,,,638.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,347.39,,,347.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,552.98,680.59,
HC SCREW CANNULATED 4 X 40MM TI ASNIS III,Sx0000604640S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,709.86,638.87,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.69,,,553.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,361.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,638.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,681.47,,,681.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.75,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.31,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,653.07,,,653.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,603.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,674.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,347.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,553.69,681.47,
HC SCREW CANNULATED 4 X 44MM TI ASNIS III,Sx0000604644S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,709.86,638.87,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.69,,,553.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,361.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,638.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,681.47,,,681.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.75,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.31,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,653.07,,,653.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,603.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,674.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,347.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,553.69,681.47,
HC SCREW CANNULATED 4 X 46MM TI ASNIS III,Sx0000604546S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,709.86,638.87,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.69,,,553.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,361.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,590.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,638.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,681.47,,,681.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.75,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,351.31,,,553.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,653.07,,,653.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,361.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,603.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.37,,,638.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.87,,,674.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,347.83,,,347.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,553.69,681.47,
HC CT PELVIS WO CONTRAST,Px00035210018,CDM,72192,CPT,350,RC,,,,BOTH,,,712,640.8,676.4,,,640.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,555.36,,,555.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,640.8,,,592.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,640.8,,,362.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,640.8,,,592.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.88,,,362.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,640.8,,,640.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683.52,,,683.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,555.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,352.37,,,555.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,655.04,,,655.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.88,,,362.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,605.2,,,605.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.4,,,640.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,640.8,,,676.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,348.88,,,348.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,555.36,683.52,
HC PR 28313 RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY CDM,Px00097500149,CDM,28313,CPT,975,RC,,,,BOTH,,,1261,1134.9,706.16,,,1134.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,460.48,,,983.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.13,,,993.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.13,,,417.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.13,,,993.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,417.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,423.8,,,1134.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,693.55,,,491.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,364.3,,,983.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,364.3,,,983.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,718.77,,,1160.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,375.23,,,642.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,718.77,,,1071.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,706.16,,,1134.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,687.6,,,1197.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,364.3,,,364.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,364.3,687.6,
HC PR 46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX  CDM,Px00097514073,CDM,46040,CPT,975,RC,,,,BOTH,,,1350,1215,756,,,1215,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,596.15,,,1053,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,843.75,,,1123.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,843.75,,,687.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,843.75,,,1123.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,488.51,,,687.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,496.25,,,1215,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,1296,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,424.79,,,1053,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.79,,,1053,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,1242,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,437.53,,,687.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,1147.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,756,,,1215,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,689.85,,,1282.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,424.79,,,424.79,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,424.79,689.85,
HC PR ED 32556 INSERT CATH PLEURA W/O IMAG GD CDM,Px00098110929,CDM,32556,CPT,981,RC,,,,OUTPATIENT,,,290,261,162.4,,,261,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,163.46,,,226.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.25,,,241.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.25,,,147.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,181.25,,,241.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,136.33,,,147.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,146.26,,,261,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,159.5,,,278.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.55,,,226.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.55,,,226.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,266.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,122.11,,,147.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,165.3,,,246.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,162.4,,,261,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,691.65,,,275.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.55,,,118.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,118.55,691.65,
HC PR ED 27752 CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM,Px00098110890,CDM,27752,CPT,981,RC,,,,OUTPATIENT,,,1989,1790.1,1113.84,,,1790.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,637.83,,,1551.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1243.13,,,1655.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1243.13,,,1013.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1243.13,,,1655.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,569.14,,,1013.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,586.24,,,1790.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1093.95,,,1909.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,1551.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,1551.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1133.73,,,1829.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,509.75,,,1013.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1133.73,,,1690.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1113.84,,,1790.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,691.65,,,1889.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,494.9,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,494.9,691.65,
HC CATH SET MELKER CRICOTHYROTOMY 6MM,Sx0C-TCCS-600,CDM,,,270,RC,,,,BOTH,,,720.9,519.67,684.86,,,648.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,562.3,,,562.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,648.81,,,600.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,648.81,,,367.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,648.81,,,600.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,353.24,,,367.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,648.81,,,648.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,692.06,,,692.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.86,,,562.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.77,,,562.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,663.23,,,663.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,353.24,,,367.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,612.77,,,612.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,684.86,,,648.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,648.81,,,684.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,353.24,,,353.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,562.3,692.06,
HC ED INCISE EXTERNAL HEMORRHOID CDM,Px00045010410,CDM,46083,CPT,450,RC,,,,OUTPATIENT,,,726,516.6,689.7,,,567.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,566.28,,,492.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.4,,,525.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.4,,,321.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.4,,,525.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.74,,,321.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,653.4,,,567.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,696.96,,,605.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,533.61,,,492.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,359.3,,,492.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,667.92,,,580.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.74,,,321.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,617.1,,,536.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.7,,,567.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.4,,,599.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,355.74,,,355.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,566.28,696.96,
HC LOCKING SCREW FULL THRD 2.7MM T10 L10MM,Sx00000657014,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,727.11,654.4,690.75,,,654.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.15,,,567.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.4,,,605.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.4,,,370.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.4,,,605.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.28,,,370.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,654.4,,,654.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.03,,,698.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,534.43,,,567.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,359.85,,,567.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,668.94,,,668.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.28,,,370.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,618.04,,,618.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.75,,,654.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,654.4,,,690.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.28,,,356.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,567.15,698.03,
HC DECLOT VASCULAR DEVICE,Px00076110489,CDM,36593,CPT,761,RC,,,,BOTH,,,728,655.2,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.84,,,567.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,370.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.88,,,698.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.08,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.76,,,669.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,618.8,,,618.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,691.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,356.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,567.84,698.88,
HC DECLOT VAD W THROMB AGENT,Px00036110005,CDM,36593,CPT,761,RC,,,,BOTH,,,728,655.2,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.84,,,567.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,370.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.88,,,698.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.08,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.76,,,669.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,618.8,,,618.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,691.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,356.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,567.84,698.88,
HC CHEMO IV INFUSION INITIAL HR,Px00033510003,CDM,96413,CPT,761,RC,,,,BOTH,,,728,655.2,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.84,,,567.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,370.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,605.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.88,,,698.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.08,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,567.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.76,,,669.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,370.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,618.8,,,618.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,691.6,,,655.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,655.2,,,691.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,356.72,,,356.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,567.84,698.88,
HC CATH BALLOON TAMPONADE 24FR 0,Sx00000G24237,CDM,,,270,RC,,,,BOTH,,,729,656.1,692.55,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.62,,,568.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,606.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,371.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,606.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,371.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,699.84,,,699.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.82,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.78,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,670.68,,,670.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,371.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,619.65,,,619.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,692.55,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,357.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,568.62,699.84,
HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,Px00092110003,CDM,93882,CPT,921,RC,,,,BOTH,,,729,656.1,692.55,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.62,,,568.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,606.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,371.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,606.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,375.51,,,371.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,699.84,,,699.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,535.82,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,670.68,,,670.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.79,,,371.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,619.65,,,619.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,692.55,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,656.1,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.21,,,357.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,568.62,699.84,
HC PR ED 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF CDM,Px00098110744,CDM,25605,CPT,981,RC,,,,OUTPATIENT,,,1222,1099.8,684.32,,,1099.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,666.4,,,953.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,763.75,,,1017.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,763.75,,,622.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,763.75,,,1017.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,597.4,,,622.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,604.8,,,1099.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,672.1,,,1173.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,953.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,953.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,696.54,,,1124.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,535.06,,,622.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,696.54,,,1038.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,684.32,,,1099.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,700.19,,,1160.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,519.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,519.48,700.19,
HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM,Px00035200001,CDM,71271,CPT,350,RC,,,,BOTH,,,730,1309.5,693.5,,,657,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.4,,,569.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657,,,607.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657,,,372.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657,,,607.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.7,,,372.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,657,,,657,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,700.8,,,700.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,536.55,,,569.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,361.28,,,569.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,671.6,,,671.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.7,,,372.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,620.5,,,620.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,693.5,,,657,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657,,,693.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,357.7,,,357.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,569.4,700.8,
HC PR 29881 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,Px00097511349,CDM,29881,CPT,975,RC,,,,BOTH,,,1287,1158.3,720.72,,,1158.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,700.62,,,1003.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,804.38,,,1063.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,804.38,,,624.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,804.38,,,1063.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,622.86,,,624.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,646.03,,,1158.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,707.85,,,734.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1003.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1003.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.59,,,1184.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,557.87,,,655.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.59,,,1093.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,1158.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,701.55,,,1222.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,701.55,
HC PR 19125 EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,Px00096910514,CDM,19125,CPT,975,RC,,,,BOTH,,,1365,1228.5,764.4,,,1228.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,588.04,,,1064.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.13,,,1093.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.13,,,524.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.13,,,1093.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,522.76,,,524.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,544.26,,,1228.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,750.75,,,616.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,454.57,,,1064.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,454.57,,,1064.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.05,,,1255.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.21,,,695.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.05,,,1160.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,764.4,,,1228.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,704.25,,,1296.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,454.57,,,454.57,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,454.57,704.25,
TIROFIBAN HCL IN NACL 0.9% IV SOLN 12.5 MG/250ML (BASE EQ),Rx25208000202,CDM,,,250,RC,25208-0002-02,NDC,,BOTH,250,ML,734.06,867.2,697.36,,,660.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,572.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.65,,,611.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.65,,,374.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.65,,,611.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.69,,,374.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,660.65,,,660.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,704.7,,,704.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,539.53,,,572.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,363.29,,,572.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.34,,,675.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.69,,,374.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.95,,,623.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.36,,,660.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,660.65,,,697.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,359.69,,,359.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,572.57,704.7,
GLUCAGON (RDNA) FOR INJ KIT 1 MG,Rx00548585000,CDM,J1610,HCPCS,636,RC,548585000,NDC,,BOTH,1,ME,734.18,660.76,697.47,,,697.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,572.66,,,572.66,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,660.76,,,660.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,660.76,,,660.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,660.76,,,660.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,359.75,,,359.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,660.76,,,660.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,704.81,,,704.81,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,539.62,,,539.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,359.75,,,359.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,675.45,,,675.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,359.75,,,359.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,624.05,,,624.05,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,697.47,,,697.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,660.76,,,660.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,359.75,,,359.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,572.66,704.81,
HC BEBTELOVIMAB INFUSION ADMIN M0222,Px00026000011,CDM,M0222,CPT,260,RC,,,,BOTH,,,735,661.5,698.25,,,661.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.3,,,573.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,611.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,374.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,611.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.15,,,374.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,661.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,705.6,,,705.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,573.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,363.75,,,573.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,676.2,,,676.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.15,,,374.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,624.75,,,624.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.25,,,661.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,698.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,360.15,,,360.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,573.3,705.6,
HC PR ED 23675 TREAT DISLOCATION/FRACTURE W/SURG NK FX CDM,Px00098110576,CDM,23675,CPT,981,RC,,,,OUTPATIENT,,,1193,1073.7,668.08,,,1073.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,649.69,,,930.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.63,,,993.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.63,,,607.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.63,,,993.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,584.02,,,607.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,591.43,,,1073.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,656.15,,,1145.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.84,,,930.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,507.84,,,930.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,680.01,,,1097.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,523.08,,,607.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,680.01,,,1014.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,668.08,,,1073.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,707.39,,,1133.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,507.84,,,507.84,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,507.84,707.39,
ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%,Rx67457022000,CDM,Q9968,HCPCS,636,RC,67457022000,NDC,,BOTH,1,ML,737.08,663.37,700.23,,,663.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.92,,,574.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.37,,,613.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.37,,,375.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.37,,,613.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.17,,,375.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,663.37,,,663.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,707.6,,,707.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,541.75,,,574.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,361.17,,,574.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,678.11,,,678.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.17,,,375.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,626.52,,,626.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,700.23,,,663.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.37,,,700.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,361.17,,,361.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,574.92,707.6,
HC PR 26055 INCISE FINGER TENDON SHEATH,Px00096910722,CDM,26055,CPT,975,RC,,,,BOTH,,,693,623.7,388.08,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,383.55,,,540.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,574.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,342.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,574.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.94,,,342.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370.01,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,381.15,,,415.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,540.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,540.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.01,,,637.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.16,,,353.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.01,,,589.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.08,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,712.35,,,658.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,298.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,298.21,712.35,
HC PR 26055 INCISE FINGER TENDON SHEATH [26055] CDM,Px00097500047,CDM,26055,CPT,983,RC,,,,BOTH,,,693,623.7,388.08,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,383.55,,,540.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,574.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,342.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,433.13,,,574.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,342.94,,,342.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370.01,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,381.15,,,415.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,540.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,540.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.01,,,637.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.16,,,353.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,395.01,,,589.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,388.08,,,623.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,712.35,,,658.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,298.21,,,298.21,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,298.21,712.35,
HC PR 38531 OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES,Px00097511292,CDM,38531,CPT,975,RC,,,,BOTH,,,1058,952.2,592.48,,,952.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,575.53,,,825.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.25,,,872.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.25,,,506.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.25,,,872.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,503.37,,,506.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,520.48,,,952.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,581.9,,,1058,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,408.54,,,825.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408.54,,,825.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.06,,,973.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,450.84,,,539.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.06,,,899.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.48,,,952.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,715.05,,,1005.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,408.54,,,408.54,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,408.54,715.05,
HC DRAPE STERI APERTURE,Sx00000001020,CDM,,,270,RC,,,,BOTH,,,746.09,6.35,708.79,,,671.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.95,,,581.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.48,,,621.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.48,,,380.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.48,,,621.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.58,,,380.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,671.48,,,671.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.25,,,716.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,548.38,,,581.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,369.24,,,581.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,686.4,,,686.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.58,,,380.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,634.18,,,634.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.79,,,671.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,671.48,,,708.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,365.58,,,365.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,581.95,716.25,
HC BLOOD TRANSFUSION EA UNIT,Px00039110001,CDM,36430,CPT,391,RC,,,,BOTH,,,749,674.1,711.55,,,674.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.22,,,584.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.1,,,623.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.1,,,381.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.1,,,623.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.01,,,381.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,674.1,,,674.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,719.04,,,719.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,550.52,,,584.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,370.68,,,584.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,689.08,,,689.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.01,,,381.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,636.65,,,636.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.55,,,674.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,674.1,,,711.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.01,,,367.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,584.22,719.04,
HC T3 AMZ SET FULKERSON TIBIAL TUBERERCLE REALIGNMENT,Sx00000T3 AMZ,CDM,,,270,RC,,,,BOTH,,,750,675,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585,,,585,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,382.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720,,,720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.25,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.18,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,690,,,690,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,637.5,,,637.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,712.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,367.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,585,720,
HC DRILL BIT 3.2MMX20MM RINGLOC+ ACET,Sx0031-323220,CDM,,,270,RC,,,,BOTH,,,750,621,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585,,,585,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,382.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720,,,720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.25,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.18,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,690,,,690,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,637.5,,,637.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,712.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,367.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,585,720,
HC ZONE NAVIGATOR CANNULA,Sx0000AR-7900,CDM,,,270,RC,,,,BOTH,,,750,675,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585,,,585,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,382.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,624.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720,,,720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.25,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.18,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,690,,,690,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,382.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,637.5,,,637.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,712.5,,,675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675,,,712.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.5,,,367.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,585,720,
HC CT MAXILLOFACIAL WO CONTRAST,Px00035110022,CDM,70486,CPT,350,RC,,,,BOTH,,,751,675.9,713.45,,,675.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,585.78,,,585.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675.9,,,625.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675.9,,,382.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675.9,,,625.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.99,,,382.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.9,,,675.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.96,,,720.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,551.99,,,585.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,371.67,,,585.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,690.92,,,690.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.99,,,382.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,638.35,,,638.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.45,,,675.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675.9,,,713.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,367.99,,,367.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,585.78,720.96,
HC MESH PROLENE HERNIA LG POLYPROPYLENE 2X4 IN CIRCLE PHSL,Sx00000ETPHSL,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,752.46,698.46,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,586.92,,,605.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,395.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,698.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.36,,,745.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.06,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.39,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.26,,,713.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.59,,,659.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,737.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,368.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,586.92,722.36,
HC MESH PROLENE HERNIA EXT UNDERLAY PHSE,Sx0000000PHSE,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,752.46,698.46,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,586.92,,,605.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,395.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,698.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.36,,,745.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.06,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.39,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.26,,,713.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.59,,,659.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,737.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,368.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,586.92,722.36,
HC MESH PROLENE HERNIA POLYPROPYLENE PHSM,Sx0000000PHSM,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,752.46,698.46,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,586.92,,,605.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,395.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,698.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.36,,,745.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.06,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.39,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.26,,,713.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.59,,,659.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,737.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,368.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,586.92,722.36,
HC MESH ULTRAPRO MED 6X12 HERNIA SYSTEM,Sx0000000UHSM,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,752.46,698.46,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,586.92,,,605.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,395.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,698.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.36,,,745.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.06,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.39,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.26,,,713.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.59,,,659.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,737.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,368.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,586.92,722.36,
HC MESH ULTRAPRO 6X12 HERNIA SYSTEM,Sx000000UHSOV,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,752.46,698.46,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,586.92,,,605.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,395.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,646.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,698.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.36,,,745.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,553.06,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,372.39,,,605.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.26,,,713.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,395.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,639.59,,,659.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,714.84,,,698.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.21,,,737.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,368.71,,,368.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,586.92,722.36,
"HC PR 49651 LAPAROSCOPY INGUINAL HERNIA REPAIR, RECURRENT",Px00097510881,CDM,49651,CPT,975,RC,,,,BOTH,,,1286,1157.4,720.16,,,1157.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,773.07,,,1003.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,803.75,,,1070.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,803.75,,,655.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,803.75,,,1070.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,637.97,,,655.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,662.01,,,1157.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,707.3,,,1234.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1003.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1003.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.02,,,1183.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,571.4,,,655.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.02,,,1093.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,720.16,,,1157.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,1221.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,724.5,
"RABIES VACCINE, PCEC FOR INJ",Rx58160096412,CDM,90675,CPT,636,RC,58160096412,NDC,,BOTH,1,ML,755.48,679.93,717.71,,,717.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,589.27,,,589.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,679.93,,,679.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,679.93,,,679.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,679.93,,,679.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,370.19,,,370.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,679.93,,,679.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,725.26,,,725.26,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,555.28,,,555.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,370.19,,,370.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,695.04,,,695.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,370.19,,,370.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,642.16,,,642.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,717.71,,,717.71,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,679.93,,,679.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,370.19,,,370.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,589.27,725.26,
HC PR 23550 TREAT CLAVICLE DISLOCATION,Px00097512017,CDM,23550,CPT,975,RC,,,,BOTH,,,1359,1223.1,761.04,,,1223.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,739.18,,,1060.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,849.38,,,1131.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,849.38,,,692.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,849.38,,,1131.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,658.21,,,692.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,669.18,,,1223.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,747.45,,,1304.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,1060.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,774.63,,,1250.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,589.53,,,692.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,774.63,,,1155.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,761.04,,,1223.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,728.09,,,1291.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,335.3,,,335.3,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,335.3,728.09,
HC PR 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,Px00097511348,CDM,29880,CPT,975,RC,,,,BOTH,,,1334,1200.6,747.04,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,725.6,,,1040.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,1102.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,648.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,1102.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,645.7,,,648.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,671.17,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.7,,,764.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1040.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1040.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,760.38,,,1227.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,578.32,,,679.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,760.38,,,1133.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,747.04,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,728.09,,,1267.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,728.09,
HC STAPLER ECS29 INTRALUMINAL PREMIUM PLUS TITANIUM 29MM,Sx00000ECS29B,CDM,,,270,RC,,,,BOTH,,,758.62,631.9,720.69,,,631.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.72,,,547.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,682.76,,,584.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,682.76,,,357.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,682.76,,,584.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.72,,,357.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,682.76,,,631.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.28,,,674.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,557.59,,,547.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,375.44,,,547.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,697.93,,,645.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.72,,,357.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,644.83,,,596.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.69,,,631.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,682.76,,,667,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,371.72,,,371.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,591.72,728.28,
HC PR ED 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM,Px00098110767,CDM,26418,CPT,981,RC,,,,OUTPATIENT,,,1498,1348.2,838.88,,,1348.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,845.57,,,1168.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,936.25,,,1246.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,936.25,,,763.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,936.25,,,1246.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,89.93,,,763.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,681.2,,,1348.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,823.9,,,1438.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,1168.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,1168.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.86,,,1378.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,80.55,,,763.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.86,,,1273.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,838.88,,,1348.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,730.34,,,1423.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,78.2,730.34,
HC T2 F/T LOCKING SCREW 5mmX45mm,Sx01896-5045S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,761.61,685.45,723.53,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594.06,,,594.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,633.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,388.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,633.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,388.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,731.15,,,731.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.78,,,594.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,376.92,,,594.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,700.68,,,700.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,388.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,647.37,,,647.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.53,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,723.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,373.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,594.06,731.15,
HC T2 F/T LOCKING SCREW 5mmX65mm,Sx01896-5065S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,761.61,685.45,723.53,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594.06,,,594.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,633.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,388.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,633.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,388.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,731.15,,,731.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.78,,,594.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,376.92,,,594.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,700.68,,,700.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,388.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,647.37,,,647.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.53,,,685.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.45,,,723.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,373.19,,,373.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,594.06,731.15,
HC PR 26160 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR,Px00097511324,CDM,26160,CPT,975,RC,,,,BOTH,,,750,675,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,414.13,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,621.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,370.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,468.75,,,621.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,370.47,,,370.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,398.41,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,412.5,,,446.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,322.15,,,585,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,322.15,,,585,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,690,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,331.81,,,382.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,427.5,,,637.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,420,,,675,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.05,,,712.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,322.15,,,322.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,322.15,733.05,
HC PR ASST SHOULDER ARTHROSCOPY/SURGERY DEBRIDEMENT,Px00097510485,CDM,29822,CPT,975,RC,,,,BOTH,,,1310,1179,733.6,,,733.6,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,700.14,,,700.14,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,818.75,,,818.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,818.75,,,818.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,818.75,,,818.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,623.63,,,623.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,677.24,,,677.24,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,720.5,,,720.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,,,74.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,746.7,,,746.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,558.56,,,558.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,746.7,,,746.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,733.6,,,733.6,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,733.5,,,733.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,733.5,
HC MESH ULTRAPRO LG 6X12 HERNIA SYSTEM,Sx0000000UHSL,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,767.07,712.04,728.72,,,712.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.31,,,617.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.36,,,658.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.36,,,403.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.36,,,658.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,375.86,,,403.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,690.36,,,712.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.39,,,759.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,563.8,,,617.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.62,,,617.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,705.7,,,727.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,375.86,,,403.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,652.01,,,672.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.72,,,712.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.36,,,751.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,375.86,,,375.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,598.31,736.39,
HC PR 28820 AMPUTATION TOE METATARSOPHALANGEAL JOINT,Px00097511347,CDM,28820,CPT,975,RC,,,,BOTH,,,422,379.8,236.32,,,379.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.82,,,329.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.75,,,347.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.75,,,199.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.75,,,347.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,198.36,,,199.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,471.58,,,379.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.1,,,544.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.49,,,329.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,172.49,,,329.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.54,,,388.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,177.66,,,215.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,240.54,,,358.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,236.32,,,379.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,736.65,,,400.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,172.49,,,172.49,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,172.49,736.65,
HC FETAL NON-STRESS TEST,Px00092010032,CDM,59025,CPT,920,RC,,,,BOTH,,,775,484.2,736.25,,,581.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.5,,,503.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,537.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,329.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,537.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,329.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,581.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,744,,,620.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.63,,,503.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,503.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,713,,,594.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,329.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,658.75,,,549.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.25,,,581.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,379.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,604.5,744,
HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM,Px00045010783,CDM,20605,CPT,450,RC,,,,OUTPATIENT,,,775,551.7,736.25,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.5,,,525.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,533.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,533.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,744,,,50.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.63,,,525.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,383.55,,,525.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,713,,,620.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,343.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,658.75,,,572.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.25,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,640.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,379.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,604.5,744,
HC ED INJECTION ANES AGENT SPHENOPALATINE GANGLION CDM,Px00045010236,CDM,64505,CPT,450,RC,,,,OUTPATIENT,,,775,551.7,736.25,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.5,,,525.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,561.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,343.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,561.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,343.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,744,,,647.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,569.63,,,525.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,383.55,,,525.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,713,,,620.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,343.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,658.75,,,572.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.25,,,606.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.5,,,640.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,379.75,,,379.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,604.5,744,
HC PR 49591 RPR AA HERNIA 1ST < 3 CM REDUCIBLE CDM,Px00097500163,CDM,49591,CPT,975,RC,,,,BOTH,,,816,734.4,456.96,,,734.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,455.01,,,636.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,510,,,670.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,510,,,380.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,510,,,670.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,378.58,,,380.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,734.4,,,734.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,448.8,,,816,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,636.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,636.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.12,,,750.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,339.08,,,415.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.12,,,693.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,456.96,,,734.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,775.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
HC PR 49592 RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED CDM,Px00097500164,CDM,49592,CPT,975,RC,,,,BOTH,,,1135,1021.5,635.6,,,1021.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,630.75,,,885.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,709.38,,,944.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,709.38,,,578.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,709.38,,,944.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,525.6,,,578.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1021.5,,,1021.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,624.25,,,1089.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,885.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,885.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,646.95,,,1044.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,470.75,,,578.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,646.95,,,964.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,635.6,,,1021.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,1078.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
HC PR 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE CDM,Px00097500165,CDM,49593,CPT,975,RC,,,,BOTH,,,1366,1229.4,764.96,,,1229.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,759.57,,,1065.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.75,,,1122.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.75,,,636.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.75,,,1122.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,632.27,,,636.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1229.4,,,1229.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,751.3,,,1366,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1065.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1065.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.62,,,1256.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,566.29,,,696.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.62,,,1161.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,764.96,,,1229.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,1297.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
HC PR 49594 RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED CDM,Px00097500166,CDM,49594,CPT,975,RC,,,,BOTH,,,1780,1602,996.8,,,1602,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,987.17,,,1388.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1112.5,,,1461.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1112.5,,,827.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1112.5,,,1461.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,821.97,,,827.21,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1602,,,1602,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,979,,,1780,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1388.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1388.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,1637.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,907.09,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,1513,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,996.8,,,1602,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,1691,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
HC PR 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE CDM,Px00097500167,CDM,49595,CPT,975,RC,,,,BOTH,,,1837,1653.3,1028.72,,,1653.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1019.9,,,1432.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1148.13,,,1529.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1148.13,,,936.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1148.13,,,1529.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,852.59,,,936.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1653.3,,,1653.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1010.35,,,1763.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1432.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1432.86,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1047.09,,,1690.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,763.62,,,936.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1047.09,,,1561.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1028.72,,,1653.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,1745.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
HC PR 49596 RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED CDM,Px00097500168,CDM,49596,CPT,975,RC,,,,BOTH,,,2440,2196,1366.4,,,2196,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1353.29,,,1903.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1525,,,2031.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1525,,,1243.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1525,,,2031.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1131.07,,,1243.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2196,,,2196,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1342,,,2342.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1903.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1903.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1390.8,,,2244.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1013.05,,,1243.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1390.8,,,2074,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1366.4,,,2196,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,745.65,,,2318,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,745.65,
ALPROSTADIL INJ 500 MCG/ML,Rx00009316901,CDM,J0270,HCPCS,636,RC,9316901,NDC,,BOTH,1,ML,778.95,701.06,740,,,701.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.58,,,607.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.06,,,648.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.06,,,396.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.06,,,648.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.69,,,396.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.06,,,701.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.79,,,747.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.53,,,607.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,381.69,,,607.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,716.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.69,,,396.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.11,,,662.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740,,,701.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.06,,,740,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.69,,,381.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.58,747.79,
HC ED INJ TRIGGER POINT 1/2 MUSCL CDM,Px00045010539,CDM,20552,CPT,450,RC,,,,OUTPATIENT,,,779,553.5,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.62,,,528.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.84,,,51.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.53,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.68,,,622.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.15,,,575.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,643.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,381.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.62,747.84,
HC ED INJ TENDON SHEATH/LIGAMENT CDM,Px00045010538,CDM,20550,CPT,450,RC,,,,OUTPATIENT,,,779,553.5,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.62,,,528.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.84,,,56.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.53,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.68,,,622.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.15,,,575.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,643.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,381.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.62,747.84,
HC ED INJECT TRIGGER POINTS =/> 3 CDM,Px00045010540,CDM,20553,CPT,450,RC,,,,OUTPATIENT,,,779,553.5,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.62,,,528.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.84,,,58.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.53,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.68,,,622.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.15,,,575.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,643.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,381.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.62,747.84,
HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM,Px00045010050,CDM,20610,CPT,450,RC,,,,OUTPATIENT,,,779,553.5,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.62,,,528.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,535.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.84,,,62.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.53,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.68,,,622.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.15,,,575.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,643.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,381.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.62,747.84,
HC ED NERVE BLOCK INJ TRIGEMINAL CDM,Px00045010459,CDM,64400,CPT,450,RC,,,,OUTPATIENT,,,779,553.5,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,607.62,,,528.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,563.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,345,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,563.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,747.84,,,649.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,572.57,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,385.53,,,528.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,716.68,,,622.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,345,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,662.15,,,575.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.05,,,609.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.1,,,643.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,381.71,,,381.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,607.62,747.84,
HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM,Px00076110551,CDM,99215,CPT,761,RC,,,,BOTH,,,780,585,741,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.4,,,608.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,608.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,608.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,702,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.8,,,147.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.3,,,608.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,608.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,717.6,,,717.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,397.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,663,,,663,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,741,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,382.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,608.4,748.8,
HC L&D TRIAGE NEW PATIENT LVL 4 CDM,Px00076100004,CDM,99204,CPT,761,RC,,,,BOTH,,,780,585,741,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.4,,,608.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,608.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,608.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,702,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.8,,,748.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.3,,,608.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,608.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,717.6,,,717.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,397.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,663,,,663,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,741,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.2,,,382.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,608.4,748.8,
CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML,Rx43598091911,CDM,,,250,RC,43598-0919-11,NDC,,BOTH,1,ML,780.19,702.17,741.18,,,702.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.55,,,608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.17,,,649.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.17,,,397.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.17,,,649.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.29,,,397.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,702.17,,,702.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.98,,,748.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.44,,,608.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,608.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,717.77,,,717.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.29,,,397.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,663.16,,,663.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741.18,,,702.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.17,,,741.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,382.29,,,382.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,608.55,748.98,
HC PR 49550 REPAIR REM HERNIA INIT REDUCE,Px00097510871,CDM,49550,CPT,975,RC,,,,BOTH,,,1334,1200.6,747.04,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.86,,,1040.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,679.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.75,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,650.79,,,679.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,685.29,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,733.7,,,1280.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1040.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1040.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,760.38,,,1227.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,582.88,,,679.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,760.38,,,1133.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,747.04,,,1200.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,749.25,,,1267.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,749.25,
HC PR 29870 KNEE ARTHROSCOPY DX,Px00096910882,CDM,29870,CPT,975,RC,,,,BOTH,,,966,869.4,540.96,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,526.24,,,753.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,804.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,492.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,603.75,,,804.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.37,,,492.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,487.55,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,531.3,,,927.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,753.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,753.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,888.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.45,,,492.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,550.62,,,821.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,869.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,752.4,,,917.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,752.4,
HC SCREW CAPTURED CORTICAL 5.0MMX40MM,Sx0008001-040,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,787.5,708.75,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.25,,,614.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,401.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,708.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756,,,756,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,578.81,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,389.73,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.38,,,669.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,748.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,385.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.25,756,
HC SCREW CAPTURED CORTICAL 5.0MMX44MM,Sx0008001-044,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,787.5,708.75,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.25,,,614.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,401.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,708.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756,,,756,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,578.81,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,389.73,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.38,,,669.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,748.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,385.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.25,756,
HC SCREW CAPTURED CORTICAL 5.0MMX50MM,Sx0008001-050,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,787.5,708.75,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.25,,,614.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,401.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,708.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756,,,756,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,578.81,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,389.73,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.38,,,669.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,748.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,385.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.25,756,
HC SCREW CAPTURED CORTICAL 5.0MMX32MM,Sx0008001-032,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,787.5,708.75,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.25,,,614.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,401.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,655.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,708.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756,,,756,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,578.81,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,389.73,,,614.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,401.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.38,,,669.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.13,,,708.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,748.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,385.88,,,385.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.25,756,
HC ED CARDIOPULMONARY RESUSCITATION CDM,Px00045014038,CDM,92950,CPT,450,RC,,,,OUTPATIENT,,,788,560.7,748.6,,,616.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.64,,,534.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,570.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,349.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,570.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,349.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,616.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756.48,,,657.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,579.18,,,534.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,389.98,,,534.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.96,,,630.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,349.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.8,,,582.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.6,,,616.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,650.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,386.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.64,756.48,
HC INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL CDM,Px00046000003,CDM,95070,CPT,460,RC,,,,BOTH,,,788,1049.4,748.6,,,1049.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.64,,,909.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,970.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,594.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,970.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,594.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,1049.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756.48,,,1119.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,579.18,,,909.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,909.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.96,,,1072.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,594.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,669.8,,,991.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.6,,,1049.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,709.2,,,1107.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.12,,,386.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,614.64,756.48,
IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT,Rx00597002402,CDM,,,250,RC,00597-0024-02,NDC,,BOTH,1,EA,789.23,690.14,749.77,,,710.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.6,,,615.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,657.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,402.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,657.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.72,,,402.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,710.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,757.66,,,757.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.08,,,615.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,390.59,,,615.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,726.09,,,726.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.72,,,402.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,670.85,,,671,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,749.77,,,710.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,749.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.72,,,386.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,615.6,757.66,
HC LINEAR CUTTER RELOADABLE ENDOSCOPIC VASCULAR THIN 35MM,Sx00000PVE35A,CDM,,,270,RC,,,,BOTH,,,789.49,739.17,750.02,,,739.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.8,,,640.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.54,,,683.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.54,,,418.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.54,,,683.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.85,,,418.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,710.54,,,739.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,757.91,,,788.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.28,,,640.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,390.72,,,640.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,726.33,,,755.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.85,,,418.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,671.07,,,698.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,750.02,,,739.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.54,,,780.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,386.85,,,386.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,615.8,757.91,
HC ED DRAINAGE OF EYELID ABSCESS CDM,Px00045010482,CDM,67700,CPT,450,RC,,,,OUTPATIENT,,,791,562.5,751.45,,,619.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,616.98,,,536.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.9,,,572.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.9,,,350.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.9,,,572.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387.59,,,350.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,711.9,,,619.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,759.36,,,660.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.39,,,536.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,391.47,,,536.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,727.72,,,632.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387.59,,,350.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,672.35,,,584.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,751.45,,,619.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.9,,,653.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,387.59,,,387.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,616.98,759.36,
HC PR 27635 REMOVE LOWER LEG BONE LESION,Px00097510957,CDM,27635,CPT,975,RC,,,,BOTH,,,1378,1240.2,771.68,,,1240.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,749.52,,,1074.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,861.25,,,1138.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,861.25,,,666.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,861.25,,,1138.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.56,,,666.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,697.68,,,1240.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,757.9,,,799.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,1074.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,1074.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,785.46,,,1267.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.53,,,702.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,785.46,,,1171.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,771.68,,,1240.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,760.04,,,1309.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,360.34,,,360.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,360.34,760.04,
HC PR 49507 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR,Px00097510870,CDM,49507,CPT,975,RC,,,,BOTH,,,1398,1258.2,782.88,,,1258.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,802.57,,,1090.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,873.75,,,1151.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,873.75,,,664.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,873.75,,,1151.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,661.1,,,664.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,697.76,,,1258.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,768.9,,,789.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1090.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1090.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,796.86,,,1286.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.12,,,712.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,796.86,,,1188.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,782.88,,,1258.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,762.29,,,1328.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,762.29,
HC TROCAR H12LP BLUNT XCEL 100MM LENGTH,Sx000000H12LP,CDM,,,270,RC,,,,BOTH,,,794.54,104.54,754.81,,,110.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,619.74,,,95.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.09,,,102.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.09,,,62.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.09,,,102.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.32,,,62.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.09,,,110.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.76,,,117.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.99,,,95.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.22,,,95.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,730.98,,,112.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.32,,,62.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.36,,,104.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,754.81,,,110.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.09,,,116.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.32,,,389.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,619.74,762.76,
HC DRILL BIT 2.0MM X 30MM,Sx00058880020,CDM,,,270,RC,,,,BOTH,,,795,715.5,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,620.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,405.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,763.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,731.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,675.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,755.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRILL BIT 2.5MM X 60MM,Sx00058850025,CDM,,,270,RC,,,,BOTH,,,795,715.5,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,620.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,405.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,763.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,731.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,675.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,755.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRILL BIT 2.8MM X 60MM,Sx00058850028,CDM,,,270,RC,,,,BOTH,,,795,715.5,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,620.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,405.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,763.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,731.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,675.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,755.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC CLAW II 2.0MM DRILL BIT,Sx00040250020,CDM,,,270,RC,,,,BOTH,,,795,715.5,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,620.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,405.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,763.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,731.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,675.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,755.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC PLATE LOCKING 8 HOLE THHIRD TUBULAR,SxAR-8943T-08,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,715.5,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,620.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,405.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,661.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,763.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,620.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,731.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,405.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,675.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,715.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,755.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC PAD WHEELCHAIR BARIATRIC LG 16 X 20 X 4.5 ALLMED LG,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,163.08,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC MONITOR NERVE BLK PRESSURE INJ BSMART,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,58.21,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC CANISTER EXTRICARE 110ML,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,81,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC INCISIONAL DRESSING FOR EXTRICARE NEG-PRESSURE,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,180,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRESSING LARGE FOR EXTRICARE NEG-PRESSURE,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,162,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRESSING MINI FOR EXTRICARE NEG-PRESSURE,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,132.75,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC HOSE TED THIGH HIGH,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,98.47,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRAPE NEGATIVE PRESSURE WOUND V.A.C. KCI,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,36.74,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC SHOULDER ABDUCTION LEFT REMEDY 2.0,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,245.7,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC SHOULDER ABDUCTION RIGHT REMEDY 2.0,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,245.7,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC ORTHO-PAT PROCESSING KIT ADVANCED TRANSFUSION,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,384.93,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL GUIDE PIN 2.3X230 LASER MARKED,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,198.9,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL GUIDE PIN & DRILL 2.75MM X 200MM LASER MARKED,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,677.03,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC K-WIRE SGL END TROCAR TIP SMOOTH 1.6X150MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,153,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL TARGETING GUIDE OLIVE WIRE THREADED 1.8MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,472.5,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC BONE FENESTRATION PERFORATOR,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,677.03,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRILL 2.4X140MM SOLID MEASURING LONG AO,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,677.03,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC OLIVE WIRE SMOOTH 1.4MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,489.6,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC MTP SPIN GUARD FEMALE REAMER 19MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,1193.4,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC MTP SPIN GUARD MALE REAMER 19,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,1193.4,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC DRILL 2.0X110MM SOLID MEASURING AO,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,677.03,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL LEFT 40MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,6540.75,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC AQUAMATYS 6.0 BIPOLAR SEALER,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,1250.18,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC TRAXI PANNICULUS RETRACTOR,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,226.61,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LINEAR RELOAD 75MM TITANIUM BLUE/RED 75MM,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,198.95,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC NASAL PAC RHINO 5.5CM GEL RAPID RHINO NASAL TAMPON,Sx0000UNKNOWN,CDM,,,270,RC,,,,BOTH,,,795,210.69,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC TROM ADVANCED POST OP BRACE KNEE XL COOL,Sx0000UNKNOWN,CDM,L1832,HCPCS,274,RC,,,,BOTH,,,795,429.17,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC POWERPORT STANDARD 7FR SINGLE LUMEN,Sx0000UNKNOWN,CDM,C1788,HCPCS,278,RC,,,,BOTH,,,795,715.5,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC V92 CELLULAR BONE MATRIX 2.5CC,Sx0000UNKNOWN,CDM,C9359,HCPCS,278,RC,,,,BOTH,,,795,6081.75,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC SEMI TENDINOSUS 7.0X280MM TENDON 7.0 X 280MM,Sx0000UNKNOWN,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,795,3351.32,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC EPIFIX MICRONIZED 100 MG,Sx0000UNKNOWN,CDM,Q4186,HCPCS,278,RC,,,,BOTH,,,795,4726.35,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC EPIFIX MICRONIZED 160 MG,Sx0000UNKNOWN,CDM,Q4186,HCPCS,278,RC,,,,BOTH,,,795,7156.35,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC EPICORD 3 CM X 5 CM,Sx0000UNKNOWN,CDM,Q4187,HCPCS,278,RC,,,,BOTH,,,795,7021.13,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC EPICORD 2 CM X 3 CM,Sx0000UNKNOWN,CDM,Q4187,HCPCS,278,RC,,,,BOTH,,,795,3373.65,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC ALLOGRAFT SEMITENDINOSUS,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,2970,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL REAMER 5.5MM CANNULATED,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,860.63,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5 X 14MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5 X 18MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5 X 20MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5 X 30MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC LAPIDUS NAIL RIGHT 38MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,6540.75,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC ANTI ROTATION PEG 3.5X20MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,860.63,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC TRUESPAN MENISCAL RPR 0 DEG JOHNSON&JOHNSON,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,1636.2,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC TRUESPAN MENISCAL RPR 24 DEG JOHNSON&JOHNSON,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,1636.2,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC MTP DISC 19 X 10MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,8032.5,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC MTP PLATE 5 DEG REV PLATE SHORT LEFT,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,6644.03,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON LOCKING PLATE SCREW 2.7 X 8MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON LOCKING PLATE SCREW 2.7 X 10MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON LOCKING PLATE SCREW 3.5 X 14MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON LOCKING PLATE SCREW 3.5 X 16MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON NON LOCKING PLATE SCREW 3.5 X 22MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,550.8,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC R3CON NON LOCKING PLATE SCREW 4.2 X 20MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,573.75,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5MM X 22MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC THREADED PEG 3.5MM X 28MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,711.45,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC ANTI ROTATION PEG 3.5MM X 10MM,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,860.63,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC SEMI TENDINOSUS 6.0X280MM TENDON,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,3351.32,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC SEMI TENDINOSUS 6.5X280 TENDON,Sx0000UNKNOWN,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,795,3351.32,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC POWERPORT LOW PROFILE 7FR SINGLE LUMEN,Sx0000UNKNOWN,CDM,C1751,HCPCS,278,RC,,,,BOTH,,,795,715.5,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC GRAFT CANCELLOUS CUBE 5CC BONE READIGRAFT ALLOGRAFT,Sx0000UNKNOWN,CDM,C1762,HCPCS,278,RC,,,,BOTH,,,795,202.15,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,620.1,,,1306.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,853.875,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1394.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.875,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.2,,,1608.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,584.33,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.45,,,1306.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,731.4,,,1541.532333,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,853.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.75,,,1424.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.25,,,1508.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,715.5,,,1591.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,389.55,,,389.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,620.1,763.2,
HC PR 64718 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,Px00097511373,CDM,64718,CPT,975,RC,,,,BOTH,,,1421,1278.9,795.76,,,1278.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,771.26,,,1108.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,888.13,,,1176.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,888.13,,,698.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,888.13,,,1176.49,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,697.79,,,698.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,706.12,,,1278.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,781.55,,,801.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.68,,,1108.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,216.68,,,1108.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,809.97,,,1307.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,624.97,,,724.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,809.97,,,1207.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,795.76,,,1278.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,764.1,,,1349.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,216.68,,,216.68,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,216.68,764.1,
SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT),Rx00006542312,CDM,,,250,RC,00006-5423-12,NDC,,BOTH,2,ML,802.18,688.19,762.07,,,762.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,625.7,,,625.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,721.96,,,721.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,721.96,,,721.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,721.96,,,721.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,393.07,,,393.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,721.96,,,721.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,770.09,,,770.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,589.6,,,589.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,397,,,397,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,738.01,,,738.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,393.07,,,393.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,681.85,,,681.85,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,762.07,,,762.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,721.96,,,721.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,393.07,,,393.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,625.7,770.09,
SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT),Rx00006542302,CDM,,,250,RC,00006-5423-02,NDC,,BOTH,2,ML,802.35,619.04,762.23,,,722.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,625.83,,,625.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.12,,,667.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.12,,,408.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.12,,,667.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.15,,,408.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,722.12,,,722.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,770.26,,,770.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,589.73,,,625.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.08,,,625.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,738.16,,,738.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.15,,,408.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,682,,,682.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.23,,,722.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,722.12,,,762.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.15,,,393.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,625.83,770.26,
HC ED IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM,Px00045010433,CDM,54220,CPT,450,RC,,,,OUTPATIENT,,,804,571.5,763.8,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.12,,,545.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.6,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.6,,,356.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.6,,,581.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,723.6,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.84,,,671.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,590.94,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,397.9,,,545.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,739.68,,,643.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,356.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,683.4,,,594.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,763.8,,,629.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.6,,,664.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,393.96,,,393.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,627.12,771.84,
HC ED REMOVE DRUG IMPLANT DEVICE CDM,Px00045001312,CDM,11982,CPT,450,RC,,,,OUTPATIENT,,,805,572.4,764.75,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.9,,,546,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,552.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,552.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.8,,,132.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.68,,,546,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.39,,,546,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.6,,,644,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,356.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,684.25,,,595,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.75,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,665,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,394.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,627.9,772.8,
HC ED INSERT NEEDLE BONE CAVITY CDM,Px00045010308,CDM,36680,CPT,450,RC,,,,OUTPATIENT,,,805,572.4,764.75,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.9,,,546,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,582.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,356.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,582.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,356.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.8,,,672,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.68,,,546,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.39,,,546,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.6,,,644,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,356.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,684.25,,,595,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.75,,,630,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,665,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,394.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,627.9,772.8,
HC NFCT DS VIR RESP RNA 3 TRGT CEPHEID#,Px00030600079,CDM,0240U,CPT,306,RC,,,,BOTH,,,805,724.5,764.75,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.9,,,627.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,410.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.8,,,772.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.68,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.39,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.6,,,740.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,684.25,,,684.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.75,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,764.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,394.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,627.9,772.8,
HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS #,Px00030600046,CDM,0241U,CPT,306,RC,,,,BOTH,,,805,724.5,764.75,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.9,,,627.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,410.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.8,,,772.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,591.68,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,398.39,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.6,,,740.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,684.25,,,684.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.75,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.5,,,764.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,394.45,,,394.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,627.9,772.8,
HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML,Rx43528000305,CDM,90739,CPT,636,RC,43528000305,NDC,,BOTH,0.5,ML,808.85,694.04,768.41,,,728.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.9,,,631.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.97,,,628.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.97,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.97,,,628.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.34,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,727.97,,,728.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,776.5,,,809.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594.5,,,631.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,396.34,,,631.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,744.14,,,744.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.34,,,412.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,687.52,,,687.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,768.41,,,728.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.97,,,768.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.34,,,396.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,630.9,776.5,
HC CT SOFT TISSUE NECK WO CONTRAST,Px00035010007,CDM,70490,CPT,350,RC,,,,BOTH,,,809,728.1,768.55,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.02,,,631.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.1,,,673.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.1,,,412.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.1,,,673.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.41,,,412.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,728.1,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,776.64,,,776.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,594.62,,,631.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,400.37,,,631.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,744.28,,,744.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.41,,,412.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,687.65,,,687.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,768.55,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.1,,,768.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.41,,,396.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,631.02,776.64,
HC DEBRIDE SUBQ TISSUE LTE 20 SQ CM,Px00076110172,CDM,11042,CPT,761,RC,,,,BOTH,,,810,729,769.5,,,729,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.8,,,631.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729,,,629.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729,,,629.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729,,,729,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,777.6,,,83.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,595.35,,,631.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,631.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,412.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,688.5,,,688.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,729,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,396.9,,,396.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,631.8,777.6,
HC INTUBATION SET RETROGRADE CUSTOM ITEM,SxC-RETRO-38J,CDM,,,270,RC,,,,BOTH,,,810.9,552.74,770.36,,,729.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,632.5,,,632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729.81,,,674.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729.81,,,413.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729.81,,,674.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.34,,,413.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.81,,,729.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,778.46,,,778.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,596.01,,,632.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.31,,,632.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,746.03,,,746.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.34,,,413.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,689.27,,,689.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,770.36,,,729.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,729.81,,,770.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,397.34,,,397.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,632.5,778.46,
HC CT THORAX WO CONTRAST,Px00035010011,CDM,71250,CPT,350,RC,,,,BOTH,,,814,732.6,773.3,,,732.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,634.92,,,634.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.6,,,677.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.6,,,414.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.6,,,677.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.86,,,414.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,732.6,,,732.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,781.44,,,781.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,598.29,,,634.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.85,,,634.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,748.88,,,748.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.86,,,414.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,691.9,,,691.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,773.3,,,732.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.6,,,773.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,398.86,,,398.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,634.92,781.44,
HC PR 45171 EXCISE RECTAL TUMOR TRANSANAL APPROACH,Px00097510749,CDM,45171,CPT,975,RC,,,,BOTH,,,1391,1251.9,778.96,,,1251.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,871.92,,,1084.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.38,,,1157.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.38,,,708.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.38,,,1157.87,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,700.27,,,708.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,720.59,,,1251.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,765.05,,,1335.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.17,,,1084.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,166.17,,,1084.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,792.87,,,1279.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,627.2,,,708.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,792.87,,,1182.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,778.96,,,1251.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,782.1,,,1321.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,166.17,,,166.17,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,166.17,782.1,
HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM,Px00045010775,CDM,43753,CPT,450,RC,,,,OUTPATIENT,,,815,580.18,774.25,,,638.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,635.7,,,553.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.5,,,590.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.5,,,361.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.5,,,590.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.35,,,361.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,733.5,,,638.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,782.4,,,680.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,599.03,,,553.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,403.34,,,553.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,749.8,,,652.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.35,,,361.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.75,,,602.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,774.25,,,638.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.5,,,673.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,399.35,,,399.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,635.7,782.4,
HC PR 43245 EGD DILATE STRICTURE,Px00097511161,CDM,43245,CPT,975,RC,,,,BOTH,,,1500,1350,840,,,1350,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,238.8,,,1170,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,937.5,,,1248.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,937.5,,,764.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,937.5,,,1248.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.79,,,764.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,213.59,,,1350,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,825,,,1440,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.38,,,1170,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,169.38,,,1170,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,855,,,1380,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,174.46,,,764.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,855,,,1275,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,840,,,1350,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,783.9,,,1425,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.38,,,169.38,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,169.38,783.9,
HC PR 44970 LAPAROSCOPY APPENDECTOMY,Px00097510741,CDM,44970,CPT,975,RC,,,,BOTH,,,1433,1289.7,802.48,,,1289.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,822.07,,,1117.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.63,,,1192.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.63,,,730.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.63,,,1192.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,675.61,,,730.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,716.55,,,1289.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.15,,,1375.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.23,,,1117.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,176.23,,,1117.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,816.81,,,1318.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,605.11,,,730.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,816.81,,,1218.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,802.48,,,1289.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,783.9,,,1361.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,176.23,,,176.23,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,176.23,783.9,
HC NEWBORN RESUSCITATION,Px00036010965,CDM,99465,CPT,410,RC,,,,BOTH,,,818,613.41,777.1,,,736.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.04,,,638.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,680.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,416.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,680.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,400.82,,,416.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,736.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.28,,,785.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.23,,,638.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,404.83,,,638.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,752.56,,,752.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,400.82,,,416.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,695.3,,,695.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,777.1,,,736.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.2,,,777.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,400.82,,,400.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,638.04,785.28,
HC PR EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,Px00097513746,CDM,28100,CPT,975,RC,,,,BOTH,,,1466,1319.4,820.96,,,1319.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,536.42,,,1143.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,916.25,,,1220.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,916.25,,,747.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,916.25,,,1220.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,481.97,,,747.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,496.73,,,1319.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,806.3,,,1407.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,419.1,,,1143.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,419.1,,,1143.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,835.62,,,1348.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,431.67,,,747.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,835.62,,,1246.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,820.96,,,1319.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,788.4,,,1392.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,419.1,,,419.1,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,419.1,788.4,
HC PUNCH BIOPSY SKIN SINGLE LESION,Px00076110316,CDM,11104,CPT,761,RC,,,,BOTH,,,822,739.8,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,641.16,,,641.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,638.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,638.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,789.12,,,822,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,756.24,,,756.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,418.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,698.7,,,698.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,780.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,402.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,641.16,789.12,
HC DRILL BIT 2.0MM/L110MM STD,Sx00XFO082001,CDM,,,270,RC,,,,BOTH,,,822,739.8,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,641.16,,,641.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,684.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,418.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,684.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,418.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,789.12,,,789.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,406.81,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,756.24,,,756.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,418.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,698.7,,,698.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,780.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,402.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,641.16,789.12,
HC DRILL 2.0X122MM WL50MM AO-SHAFT,Sx00000703701,CDM,,,270,RC,,,,BOTH,,,822,739.8,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,641.16,,,641.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,684.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,418.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,684.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,418.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,789.12,,,789.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,406.81,,,641.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,756.24,,,756.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,418.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,698.7,,,698.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.9,,,739.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.8,,,780.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,402.78,,,402.78,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,641.16,789.12,
HC PR 49623 RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR CDM,Px00097500197,CDM,49623,CPT,975,RC,,,,BOTH,,,470,423,263.2,,,423,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,260.82,,,366.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.75,,,391.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.75,,,239.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.75,,,391.23,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,222.58,,,239.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,423,,,423,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.5,,,451.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,366.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,366.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.9,,,432.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.36,,,239.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,267.9,,,399.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,263.2,,,423,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,446.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49613 RPR AA HERNIA RECR < 3 CM REDUCIBLE CDM,Px00097500169,CDM,49613,CPT,975,RC,,,,BOTH,,,1005,904.5,562.8,,,904.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,560.48,,,783.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,628.13,,,825.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,628.13,,,469.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,628.13,,,825.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,465.57,,,469.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,904.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,552.75,,,1005,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,783.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,783.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,572.85,,,924.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.99,,,512.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,572.85,,,854.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,562.8,,,904.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,954.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49614 RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED CDM,Px00097500170,CDM,49614,CPT,975,RC,,,,BOTH,,,1363,1226.7,763.28,,,1226.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,757.6,,,1063.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,851.88,,,1134.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,851.88,,,694.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,851.88,,,1134.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,630.52,,,694.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1226.7,,,1226.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,749.65,,,1308.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1063.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1063.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,776.91,,,1253.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,564.73,,,694.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,776.91,,,1158.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,763.28,,,1226.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,1294.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49615 RPR AA HERNIA RECR 3-10 CM REDUCIBLE CDM,Px00097500171,CDM,49615,CPT,975,RC,,,,BOTH,,,1525,1372.5,854,,,1372.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,847.45,,,1189.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,953.13,,,1269.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,953.13,,,777.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,953.13,,,1269.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,705.01,,,777.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1372.5,,,1372.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,838.75,,,1464,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1189.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1189.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.25,,,1403,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,631.44,,,777.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.25,,,1296.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,854,,,1372.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,1448.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49621 RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE CDM,Px00097500195,CDM,49621,CPT,975,RC,,,,BOTH,,,1768,1591.2,990.08,,,1591.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,984.28,,,1379.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1105,,,1471.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1105,,,900.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1105,,,1471.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,831.19,,,900.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1591.2,,,1591.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,972.4,,,1697.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1379.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1379.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1007.76,,,1626.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,744.45,,,900.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1007.76,,,1502.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,990.08,,,1591.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,1679.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49616 RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED CDM,Px00097500172,CDM,49616,CPT,975,RC,,,,BOTH,,,2048,1843.2,1146.88,,,1843.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1135.95,,,1597.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1280,,,1704.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1280,,,1043.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1280,,,1704.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.76,,,1043.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1843.2,,,1843.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1126.4,,,1966.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1597.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1597.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1167.36,,,1884.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,847.07,,,1043.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1167.36,,,1740.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1146.88,,,1843.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,1945.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49617 RPR AA HERNIA RECR > 10 CM REDUCIBLE CDM,Px00097500173,CDM,49617,CPT,975,RC,,,,BOTH,,,2110,1899,1181.6,,,1899,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1171.9,,,1645.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1318.75,,,1756.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1318.75,,,1075.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1318.75,,,1756.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,979.73,,,1075.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1899,,,1899,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1160.5,,,2025.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1645.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1645.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1202.7,,,1941.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,1075.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1202.7,,,1793.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1181.6,,,1899,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,2004.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49622 RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED CDM,Px00097500196,CDM,49622,CPT,975,RC,,,,BOTH,,,2182,1963.8,1221.92,,,1963.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1213.41,,,1701.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1363.75,,,1816.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1363.75,,,1111.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1363.75,,,1816.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1032.41,,,1111.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1963.8,,,1963.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1200.1,,,2094.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1701.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1701.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1243.74,,,2007.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,924.68,,,1111.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1243.74,,,1854.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1221.92,,,1963.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,2072.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 49618 RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED CDM,Px00097500174,CDM,49618,CPT,975,RC,,,,BOTH,,,2956,2660.4,1655.36,,,2660.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1638.84,,,2305.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1847.5,,,2460.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1847.5,,,1506.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1847.5,,,2460.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1370.74,,,1506.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2660.4,,,2660.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1625.8,,,2837.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,2305.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,2305.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1684.92,,,2719.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1227.71,,,1506.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1684.92,,,2512.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1655.36,,,2660.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,789.75,,,2808.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,789.75,
HC PR 24340 REPAIR OF BICEPS TENDON AT ELBOW,Px00097510616,CDM,24340,CPT,975,RC,,,,BOTH,,,1470,1323,823.2,,,1323,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,799.37,,,1146.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,918.75,,,1223.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,918.75,,,749.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,918.75,,,1223.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,698.22,,,749.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,729.68,,,1323,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,1411.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,1146.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,1146.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,837.9,,,1352.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,625.36,,,749.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,837.9,,,1249.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,823.2,,,1323,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,790.65,,,1396.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,63.88,,,63.88,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,63.88,790.65,
HC DISP KIT FOR DX SWIVELOCK SL 3.5 X 8.5MM,SxAR-8978DS-0,CDM,,,270,RC,,,,BOTH,,,825,742.5,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,643.5,,,643.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,420.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,792,,,792,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.38,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408.29,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759,,,759,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.25,,,701.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,783.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,404.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,643.5,792,
HC PIN SET UNIVERSAL II/ECLIPSE,Sx000AR-9207S,CDM,,,270,RC,,,,BOTH,,,825,742.5,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,643.5,,,643.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,420.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,792,,,792,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.38,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408.29,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759,,,759,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.25,,,701.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,783.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,404.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,643.5,792,
HC DRILL CANNULTD FOR AC REPAIR,SxAR-2257D-30,CDM,,,270,RC,,,,BOTH,,,825,742.5,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,643.5,,,643.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,420.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,686.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,792,,,792,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,606.38,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,408.29,,,643.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759,,,759,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,420.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,701.25,,,701.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.75,,,742.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.5,,,783.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,404.25,,,404.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,643.5,792,
HC PR 20680 REMOVAL IMPLANT DEEP  CDM,Px00097514030,CDM,20680,CPT,975,RC,,,,BOTH,,,990,891,554.4,,,891,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,536.34,,,772.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,618.75,,,818.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,618.75,,,480.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,618.75,,,818.17,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,478.79,,,480.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,504.07,,,891,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,544.5,,,577.13,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.34,,,772.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,416.34,,,772.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,910.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,428.83,,,504.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,564.3,,,841.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,554.4,,,891,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,794.25,,,940.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,416.34,,,416.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,416.34,794.25,
HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB #,Px00031010674,CDM,88377,CPT,300,RC,,,,BOTH,,,828,745.2,786.6,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,645.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,689.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,421.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,689.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,421.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.88,,,794.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.58,,,645.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,409.78,,,645.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,761.76,,,761.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,421.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,703.8,,,703.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,786.6,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,786.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,405.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,645.84,794.88,
HC CT HEAD/BRAIN W CONTRAST,Px00035110007,CDM,70460,CPT,350,RC,,,,BOTH,,,828,745.2,786.6,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,645.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,689.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,421.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,689.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,421.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.88,,,794.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,608.58,,,645.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,409.78,,,645.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,761.76,,,761.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,421.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,703.8,,,703.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,786.6,,,745.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,745.2,,,786.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,405.72,,,405.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,645.84,794.88,
HC PR 25545 TREAT FRACTURE OF ULNA SHAFT,Px00097510935,CDM,25545,CPT,975,RC,,,,BOTH,,,1438,1294.2,805.28,,,1294.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,808.3,,,1121.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,898.75,,,1196.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,898.75,,,732.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,898.75,,,1196.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,724.01,,,732.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,740.47,,,1294.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,790.9,,,1380.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,1121.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,1121.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,819.66,,,1322.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,648.46,,,732.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,819.66,,,1222.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,805.28,,,1294.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,803.25,,,1366.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,467.03,,,467.03,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,467.03,803.25,
HC PR 27328 EXC THIGH/KNEE TUM DEEP <5CM,Px00097510943,CDM,27328,CPT,975,RC,,,,BOTH,,,1477,1329.3,827.12,,,1329.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,793.45,,,1152.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,923.13,,,1229.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,923.13,,,752.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,923.13,,,1229.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,708.75,,,752.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,740.69,,,1329.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,812.35,,,1417.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,1152.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,1152.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,841.89,,,1358.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,634.79,,,752.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,841.89,,,1255.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,827.12,,,1329.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,804.14,,,1403.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,314.56,,,314.56,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,314.56,804.14,
HC ED I & D OF VULVA/PERINEUM CDM,Px00045010440,CDM,56405,CPT,450,RC,,,,OUTPATIENT,,,838,596.7,796.1,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.64,,,568.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,754.2,,,572.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,754.2,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,754.2,,,572.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.62,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,754.2,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.48,,,148.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.93,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,414.73,,,568.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,770.96,,,670.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.62,,,371.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,712.3,,,619.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.1,,,656.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,754.2,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,410.62,,,410.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,653.64,804.48,
"HC PR 29877 KNEE SCOPE,SHAVE ARTICULAR CART [29877] CDM",Px00097500050,CDM,29877,CPT,975,RC,,,,BOTH,,,1474,1326.6,825.44,,,1326.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,800.34,,,1149.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,921.25,,,1217.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,921.25,,,714.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,921.25,,,1217.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,712.71,,,714.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,740.97,,,1326.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,810.7,,,845.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1149.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1149.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,840.18,,,1356.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,638.34,,,751.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,840.18,,,1252.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,825.44,,,1326.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,805.95,,,1400.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,805.95,
TBO-FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML,Rx63459091011,CDM,J1447,HCPCS,636,RC,63459091011,NDC,,BOTH,0.5,ML,850.23,765.81,807.72,,,765.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.18,,,663.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.21,,,707.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.21,,,433.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.21,,,707.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.61,,,433.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,765.21,,,765.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,816.22,,,816.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.92,,,663.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,416.61,,,663.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,782.21,,,782.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.61,,,433.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,722.7,,,722.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,807.72,,,765.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.21,,,807.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,416.61,,,416.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,663.18,816.22,
HC SCREW LOCKING 3.5 X 16MM IMPL,Sx000PLSL3516,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,855,769.5,812.25,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,666.9,,,666.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,711.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,435.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,711.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,435.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,820.8,,,820.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.43,,,666.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,423.14,,,666.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,786.6,,,786.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,435.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,726.75,,,726.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.25,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,812.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,418.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,666.9,820.8,
HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,Px00092110018,CDM,93976,CPT,921,RC,,,,BOTH,,,855,769.5,812.25,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,666.9,,,666.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,711.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,435.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,711.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,440.41,,,435.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,820.8,,,820.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,628.43,,,666.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,666.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,786.6,,,786.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,436.05,,,435.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,726.75,,,726.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.25,,,769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.5,,,812.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,418.95,,,418.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,666.9,820.8,
HC PR 49520 RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE  CDM,Px00097514079,CDM,49520,CPT,975,RC,,,,BOTH,,,1507,1356.3,843.92,,,1356.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,863.34,,,1175.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,941.88,,,1241.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,941.88,,,714.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,941.88,,,1241.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,710.49,,,714.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,751.87,,,1356.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,828.85,,,851.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1175.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1175.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,858.99,,,1386.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,636.35,,,767.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,858.99,,,1280.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,843.92,,,1356.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,823.5,,,1431.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,823.5,
HC CER OPTION TYPE 1 TPR SLEVE -6,Sx000650-1064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,858,772.2,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.24,,,669.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,437.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.68,,,823.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.63,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.62,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.36,,,789.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.3,,,729.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,420.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,669.24,823.68,
HC CER OPT TYPE 1 TPR SLEVE 0MM,Sx000650-1066,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,858,772.2,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.24,,,669.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,437.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.68,,,823.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.63,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.62,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.36,,,789.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.3,,,729.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,420.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,669.24,823.68,
HC CER OPTION TYPE 1 TPR SLEVE +6,Sx000650-1068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,858,772.2,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.24,,,669.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,437.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.68,,,823.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.63,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.62,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.36,,,789.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.3,,,729.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,420.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,669.24,823.68,
HC SCREW AUTOFIX 2.5 X 30MM IMPL,Sx000141-2530,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,858,772.2,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.24,,,669.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,437.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.68,,,823.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.63,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.62,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.36,,,789.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.3,,,729.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,420.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,669.24,823.68,
HC SCREW AUTOFIX 2.5 X 26MM IMPL,Sx000141-2526,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,858,772.2,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.24,,,669.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,437.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,714.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.68,,,823.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,630.63,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,424.62,,,669.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.36,,,789.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,437.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,729.3,,,729.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,420.42,,,420.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,669.24,823.68,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML,Rx13533080020,CDM,J1561,HCPCS,636,RC,13533080020,NDC,,BOTH,50,ML,862.44,960.68,819.32,,,819.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,672.7,,,672.7,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,776.2,,,776.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,776.2,,,776.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,776.2,,,776.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,422.6,,,422.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,776.2,,,776.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,827.94,,,827.94,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,633.89,,,633.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,422.6,,,422.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,793.44,,,793.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,422.6,,,422.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,733.07,,,733.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,819.32,,,819.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,776.2,,,776.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,422.6,,,422.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,672.7,827.94,
HC PR ED 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM,Px00098110835,CDM,26951,CPT,981,RC,,,,OUTPATIENT,,,197,177.3,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.4,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,123.13,,,163.98,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,421.29,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,768.82,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.35,,,189.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,366.34,,,153.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,366.34,,,153.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.29,,,181.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,377.33,,,100.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,112.29,,,167.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,110.32,,,177.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,828.45,,,187.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,366.34,,,366.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,366.34,828.45,
HC PR 27509 PERCUTANEOUS FIXATION FEMORAL,Px00097510949,CDM,27509,CPT,975,RC,,,,BOTH,,,1602,1441.8,897.12,,,1441.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,876.6,,,1249.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1001.25,,,1333.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1001.25,,,816.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1001.25,,,1333.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,675.51,,,816.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,765.37,,,1441.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,881.1,,,1537.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,504.22,,,1249.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,504.22,,,1249.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,913.14,,,1473.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,695.78,,,816.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,913.14,,,1361.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,897.12,,,1441.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,828.9,,,1521.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,504.22,,,504.22,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,504.22,828.9,
HC PR 58661 LAPAROSCOPY REMOVE ADNEXA,Px00097511110,CDM,58661,CPT,975,RC,,,,BOTH,,,1564,1407.6,875.84,,,1407.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,761,,,1219.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,977.5,,,1287.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,977.5,,,738.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,977.5,,,1287.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,729.42,,,738.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,762.29,,,1407.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,860.2,,,888.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,1219.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,1219.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,891.48,,,1438.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,653.31,,,797.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,891.48,,,1329.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,875.84,,,1407.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,831.15,,,1485.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,393.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.5,831.15,
HC DRILL A-O STYLE 4.0MM X 165MM,Sx00S0210-200,CDM,,,270,RC,,,,BOTH,,,866.25,779.63,822.94,,,779.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,675.68,,,675.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,779.63,,,721.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,779.63,,,441.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,779.63,,,721.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.46,,,441.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,779.63,,,779.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,636.69,,,675.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,428.71,,,675.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,796.95,,,796.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.46,,,441.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,736.31,,,736.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,822.94,,,779.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,779.63,,,822.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.46,,,424.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,675.68,831.6,
HC CT MAXILLOFACIAL W CONTRAST,Px00035110030,CDM,70487,CPT,350,RC,,,,BOTH,,,867,780.3,823.65,,,780.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.26,,,676.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.3,,,721.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.3,,,441.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.3,,,721.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.83,,,441.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,780.3,,,780.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,832.32,,,832.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637.25,,,676.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,429.08,,,676.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,797.64,,,797.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.83,,,441.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,736.95,,,736.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.65,,,780.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.3,,,823.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,424.83,,,424.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,676.26,832.32,
HC K-WIRE 3 X 285MM,Sx02351-3028S,CDM,,,270,RC,,,,BOTH,,,873,785.7,829.35,,,785.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,680.94,,,680.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.7,,,726.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.7,,,444.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.7,,,726.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.77,,,444.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.7,,,785.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,838.08,,,838.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,641.66,,,680.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,432.05,,,680.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,803.16,,,803.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.77,,,444.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,742.05,,,742.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,829.35,,,785.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.7,,,829.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,427.77,,,427.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,680.94,838.08,
HC PR 27792 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,Px00097511334,CDM,27792,CPT,975,RC,,,,BOTH,,,1532,1378.8,857.92,,,1378.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,832.01,,,1194.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,957.5,,,1265.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,957.5,,,743.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,957.5,,,1265.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,737.84,,,743.03,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,774.23,,,1378.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,842.6,,,886.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,1194.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,1194.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,873.24,,,1409.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,660.85,,,780.71,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,873.24,,,1302.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,857.92,,,1378.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,844.65,,,1455.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.25,,,393.25,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.25,844.65,
HC PR 19301 MASTECTOMY PARTIAL  CDM,Px00097514024,CDM,19301,CPT,975,RC,,,,BOTH,,,1570,1413,879.2,,,1413,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,836.19,,,1224.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.25,,,1293.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.25,,,745.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.25,,,1293.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,739.55,,,745.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,773.11,,,1413,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,863.5,,,876.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,429.63,,,1224.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,429.63,,,1224.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,894.9,,,1444.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,662.38,,,800.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,894.9,,,1334.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,879.2,,,1413,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,846.45,,,1491.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,429.63,,,429.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,429.63,846.45,
HC CT ABD & PELVIS WO CONTRAST,Px00035010024,CDM,74176,CPT,350,RC,,,,BOTH,,,1800,794.7,838.85,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,688.74,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.7,,,1494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.7,,,918,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.7,,,1494,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.67,,,918,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,794.7,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,847.68,,,1728,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,649.01,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,812.36,,,1656,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.67,,,918,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,750.55,,,1530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,838.85,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,794.7,,,1710,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,432.67,,,882,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,688.74,847.68,
HC DRESSING PICO 7 NEGITIVE PRESSURE 10X20 W/PUMP,Sx00066022012,CDM,,,270,RC,,,,BOTH,,,885,796.5,840.75,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.3,,,690.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,736.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,451,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,736.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,451,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.6,,,849.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,650.48,,,690.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.99,,,690.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,814.2,,,814.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,451,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,752.25,,,752.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,840.75,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,840.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,433.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,690.3,849.6,
HC DISPOSABLES KIT FOR 3 X 8MM TENODESIS SCREW,Sx00AR-1530DS,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,885,796.5,840.75,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.3,,,690.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,736.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,451,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,736.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,451,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.6,,,849.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,650.48,,,690.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,437.99,,,690.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,814.2,,,814.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,451,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,752.25,,,752.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,840.75,,,796.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.5,,,840.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,433.65,,,433.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,690.3,849.6,
HC ED EXCISION CHALAZION SINGLE CDM,Px00045010737,CDM,67800,CPT,450,RC,,,,OUTPATIENT,,,889,632.7,844.55,,,695.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,693.42,,,602.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,800.1,,,643.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,800.1,,,393.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,800.1,,,643.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.61,,,393.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,800.1,,,695.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.44,,,742.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,653.42,,,602.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,439.97,,,602.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,817.88,,,711.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.61,,,393.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,755.65,,,657.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,844.55,,,695.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,800.1,,,734.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,435.61,,,435.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,693.42,853.44,
HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY,Px00097510818,CDM,47562,CPT,975,RC,,,,BOTH,,,1571,1413.9,879.76,,,1413.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,899.32,,,1225.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.88,,,1293.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.88,,,743.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.88,,,1293.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,740.09,,,743.53,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,783.86,,,1413.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,864.05,,,887.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,1225.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,1225.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.47,,,1445.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,662.87,,,800.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.47,,,1335.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,879.76,,,1413.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,857.7,,,1492.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,147.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,147.55,857.7,
"ESTROGENS, CONJUGATED FOR INJ 25 MG",Rx00046074905,CDM,J1410,HCPCS,636,RC,46074905,NDC,,BOTH,25,ME,893.97,781.75,849.27,,,804.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.3,,,697.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.57,,,744.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.57,,,455.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.57,,,744.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.05,,,455.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.57,,,804.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,858.21,,,858.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657.07,,,697.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,438.05,,,697.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.45,,,822.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.05,,,455.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759.87,,,760.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.27,,,804.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.57,,,849.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.05,,,438.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,697.3,858.21,
HC SCREW AUTOFIX 3.0X36MM,Sx000141-3036,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,894,804.6,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.32,,,697.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,455.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,858.24,,,858.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657.09,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.44,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.48,,,822.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759.9,,,759.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,849.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,438.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,697.32,858.24,
HC SCREW CAN AUTOFIX 16MM X 3.0MM T10 SS,Sx000141-3016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,894,804.6,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.32,,,697.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,455.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,858.24,,,858.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657.09,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.44,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.48,,,822.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759.9,,,759.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,849.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,438.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,697.32,858.24,
HC SCREW CAN AUTOFIX 18MM X 3.0MM T10 SS,Sx000414-3018,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,894,804.6,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.32,,,697.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,455.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,858.24,,,858.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657.09,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.44,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.48,,,822.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759.9,,,759.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,849.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,438.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,697.32,858.24,
HC SCREW CAN AUTOFIX 20MM X 3.0MM T10 SS,Sx000141-3020,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,894,804.6,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.32,,,697.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,455.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,744.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,858.24,,,858.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,657.09,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.44,,,697.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.48,,,822.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,455.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,759.9,,,759.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.3,,,804.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.6,,,849.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,438.06,,,438.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,697.32,858.24,
HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY,Px00097510979,CDM,29824,CPT,975,RC,,,,BOTH,,,1605,1444.5,898.8,,,1444.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,872.28,,,1251.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1003.13,,,1326.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1003.13,,,779.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1003.13,,,1326.37,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,776.89,,,779.39,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,795.44,,,1444.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,882.75,,,918.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1251.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1251.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,914.85,,,1476.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,695.83,,,817.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,914.85,,,1364.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,898.8,,,1444.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,863.1,,,1524.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,863.1,
HC L&D TRIAGE NEW PATIENT LVL 5 CDM,Px00076100005,CDM,99205,CPT,761,RC,,,,BOTH,,,900,675,855,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,693.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,693.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,810,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,225.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,702,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,441,,,702,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828,,,828,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,765,,,765,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,441,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,702,864,
HC K-WIRE 3.2 X 450MM,Sx01210-6450S,CDM,,,270,RC,,,,BOTH,,,900,810,855,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702,,,702,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,749.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,458.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,749.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,810,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,661.5,,,702,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,445.41,,,702,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828,,,828,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,458.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,765,,,765,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,810,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,441,,,441,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,702,864,
EPOETIN ALFA INJ 10000 UNIT/ML,Rx59676031000,CDM,J0885,HCPCS,636,RC,59676031000,NDC,,BOTH,1,ML,902.91,812.62,857.76,,,812.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,704.27,,,704.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.62,,,751.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.62,,,460.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.62,,,751.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.43,,,460.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,812.62,,,812.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,866.79,,,866.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,663.64,,,704.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,442.43,,,704.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,830.68,,,830.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.43,,,460.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,767.47,,,767.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,857.76,,,812.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,812.62,,,857.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,442.43,,,442.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,704.27,866.79,
HC KIT HICKMAN 9.6 F SINGLE LUMEN CATHETER W/ SURECUFF,Sx00000600560,CDM,,,270,RC,,,,BOTH,,,906.03,815.43,860.73,,,815.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,706.7,,,706.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.43,,,754.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.43,,,461.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.43,,,754.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.95,,,461.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,815.43,,,815.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,869.79,,,869.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.93,,,706.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,448.39,,,706.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,833.55,,,833.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.95,,,461.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,770.13,,,770.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,860.73,,,815.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.43,,,860.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,443.95,,,443.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,706.7,869.79,
HC PR 57287 RMVL/REVJ SLING STRESS INCONTINENCE  CDM,Px00097514093,CDM,57287,CPT,975,RC,,,,BOTH,,,1775,1597.5,994,,,1597.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,874.56,,,1384.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1109.38,,,1477.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1109.38,,,904.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1109.38,,,1477.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,835.84,,,904.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,805.18,,,1597.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,976.25,,,1704,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.9,,,1384.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,118.9,,,1384.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1011.75,,,1633,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,748.62,,,904.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1011.75,,,1508.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,994,,,1597.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,870.3,,,1686.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.9,,,118.9,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,118.9,870.3,
FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE),Rx59338077501,CDM,Q0138,HCPCS,636,RC,59338077501,NDC,,BOTH,17,ML,910.65,503.2,865.12,,,819.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.31,,,710.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819.59,,,758.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819.59,,,464.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819.59,,,758.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,446.22,,,464.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,819.59,,,819.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,874.22,,,874.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,669.33,,,710.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,446.22,,,710.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,837.8,,,838.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,446.22,,,464.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,774.05,,,774.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,865.12,,,819.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819.59,,,865.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,446.22,,,446.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,710.31,874.22,
HC PR 27829 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,Px00097511337,CDM,27829,CPT,975,RC,,,,BOTH,,,1693,1523.7,948.08,,,1523.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,922.22,,,1320.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1058.13,,,1397.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1058.13,,,815.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1058.13,,,1397.47,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,806.76,,,815.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,828.9,,,1523.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,931.15,,,929.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.29,,,1320.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,498.29,,,1320.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,965.01,,,1557.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,722.59,,,862.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,965.01,,,1439.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,948.08,,,1523.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,884.24,,,1608.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,498.29,,,498.29,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,498.29,884.24,
TIOTROPIUM BROMIDE MONOHYDRATE INHAL AEROSOL 2.5 MCG/ACT,Rx00597010061,CDM,,,250,RC,00597-0100-61,NDC,,BOTH,0.0025,ME,922.32,806.54,876.2,,,830.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,719.41,,,719.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.09,,,767.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.09,,,470.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.09,,,767.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.94,,,470.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,830.09,,,830.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,885.43,,,885.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,677.91,,,719.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,456.46,,,719.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,848.53,,,848.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.94,,,470.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,783.97,,,784.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,876.2,,,830.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.09,,,876.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,451.94,,,451.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,719.41,885.43,
HC LOCKING SCREW T10 2.7X10MM,Sx00000614510,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,924,831.6,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,720.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,470.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.04,,,887.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.29,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,850.08,,,850.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.4,,,785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,877.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,452.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,720.72,887.04,
HC LOCKING SCREW T10 2.7X14MM,Sx00000614514,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,924,831.6,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,720.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,470.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.04,,,887.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.29,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,850.08,,,850.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.4,,,785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,877.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,452.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,720.72,887.04,
HC LOCKING SCREW T10 2.7X16MM,Sx00000614516,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,924,831.6,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,720.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,470.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.04,,,887.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.29,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,850.08,,,850.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.4,,,785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,877.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,452.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,720.72,887.04,
HC LOCKING SCREW T10 2.7X26MM,Sx00000614526,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,924,831.6,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,720.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,470.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.04,,,887.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.29,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,850.08,,,850.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.4,,,785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,877.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,452.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,720.72,887.04,
HC LOCKING SCREW T10 2.7X38MM,Sx00000614538,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,924,831.6,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.72,,,720.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,470.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,769.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.04,,,887.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,457.29,,,720.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,850.08,,,850.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,470.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,785.4,,,785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.8,,,831.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.6,,,877.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,452.76,,,452.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,720.72,887.04,
HC DRILL CALIBRATED 4.0MM X 280MM,Sx00S0219-100,CDM,,,270,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 18MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW KREULOCK COMPRESSION SS 3.5X16MM,SxAR-8835CL-1,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 10MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 12MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 14MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 16MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 3.0 X 16MM VAL KREULOCK,SxAR-8933VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW KREULOCK COMPRESSION SS 3.5X20MM,SxAR-8835CL-2,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 3.0 X 14MM VAL KREULOCK,SxAR-8933VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 3.0 X 18MM VAL KREULOCK,SxAR-8933VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,472.5,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 3.0 X 12MM VAL KREULOCK,SxAR-8933VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,796.5,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW KREULOCK TI 3.5X14MM,SxAR-8935CL-1,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW KREULOCK TI 3.5X16MM,SxAR-8935CL-1,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 3.0 X 10MM VAL KREULOCK,SxAR-8933VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW KRUELOCK TI 3.5X18MM,SxAR-8935CL-1,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,796.5,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 20MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,836.33,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC SCREW TI 2.4 X 22MM VAL KREULOCK,SxAR-8724VCL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,929.25,796.5,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.82,,,724.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,473.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,773.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.08,,,892.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,459.89,,,724.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.91,,,854.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,473.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.86,,,789.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.79,,,836.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,836.33,,,882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.33,,,455.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,724.82,892.08,
HC ED BEBTELOVIMAB INFUSION ADMIN M0222,Px00045000075,CDM,M0222,CPT,450,RC,,,,OUTPATIENT,,,930,661.5,883.5,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.4,,,631.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,837,,,673.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,837,,,412.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,837,,,673.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.7,,,412.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,837,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,892.8,,,776.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,683.55,,,631.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,460.26,,,631.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855.6,,,744.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.7,,,412.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,790.5,,,687.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,883.5,,,728.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,837,,,768.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,455.7,,,455.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,725.4,892.8,
HC CUTTER FLEX 60 ARTICULATING EC60A,Sx000000EC60A,CDM,,,270,RC,,,,BOTH,,,932.72,781.61,886.08,,,781.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.52,,,677.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.45,,,722.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.45,,,442.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.45,,,722.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.03,,,442.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,839.45,,,781.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.41,,,833.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.55,,,677.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.6,,,677.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.1,,,798.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.03,,,442.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,792.81,,,738.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.08,,,781.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.45,,,825.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.03,,,457.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,727.52,895.41,
HC DRILL 2.6X122MM WL70MM AO-SHAFT,Sx00000703702,CDM,,,270,RC,,,,BOTH,,,933,839.7,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.74,,,727.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,475.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.68,,,895.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.76,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.74,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.36,,,858.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,793.05,,,793.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,886.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,457.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,727.74,895.68,
HC OVERDRILL 2.7 DIA FOR LAGGING SCREWS,Sx00000703703,CDM,,,270,RC,,,,BOTH,,,933,839.7,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.74,,,727.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,475.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.68,,,895.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.76,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.74,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.36,,,858.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,793.05,,,793.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,886.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,457.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,727.74,895.68,
HC OVERDRILL 3.5 DIA FOR LAGGING SCREWS,Sx00000703704,CDM,,,270,RC,,,,BOTH,,,933,839.7,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.74,,,727.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,475.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,776.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.68,,,895.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,685.76,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,461.74,,,727.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.36,,,858.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,475.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,793.05,,,793.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.35,,,839.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.7,,,886.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,457.17,,,457.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,727.74,895.68,
HC PR 49610 RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG CDM,Px00097513038,CDM,49610,CPT,975,RC,,,,BOTH,,,1667,1500.3,933.52,,,1500.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.48,,,1300.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1041.88,,,1387.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1041.88,,,849.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1041.88,,,1387.61,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,779.16,,,849.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,818.22,,,1500.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,916.85,,,1600.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1300.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1300.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,950.19,,,1533.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,697.86,,,849.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,950.19,,,1416.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.52,,,1500.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,897.75,,,1583.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,897.75,
PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML,Rx60793070102,CDM,J0561,HCPCS,636,RC,60793070102,NDC,,BOTH,2,ML,943.61,484.63,896.43,,,849.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,736.02,,,736.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.25,,,785.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.25,,,480.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.25,,,785.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,462.37,,,480.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,849.25,,,849.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,905.87,,,905.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,693.55,,,736.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,462.37,,,736.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,868.12,,,868.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,462.37,,,480.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,802.07,,,802.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.43,,,849.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.25,,,896.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,462.37,,,462.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,736.02,905.87,
HC PR 58662 LAPAROSCOPY EXCISE LESIONS,Px00097511111,CDM,58662,CPT,975,RC,,,,BOTH,,,1709,1538.1,957.04,,,1538.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833,,,1333.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1068.13,,,1407,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1068.13,,,808.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1068.13,,,1407,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,798.59,,,808.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.08,,,1538.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,939.95,,,972.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,1333.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,1333.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,974.13,,,1572.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,715.26,,,870.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,974.13,,,1452.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,957.04,,,1538.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,1623.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,393.5,,,393.5,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,393.5,906.3,
HC PR 29882 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,Px00097511350,CDM,29882,CPT,975,RC,,,,BOTH,,,1638,1474.2,917.28,,,1474.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,886.15,,,1277.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1023.75,,,1352.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1023.75,,,789.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1023.75,,,1352.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,787.24,,,789.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,833.9,,,1474.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,900.9,,,950,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1277.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1277.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.66,,,1506.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,705.1,,,834.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.66,,,1392.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,917.28,,,1474.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,908.1,,,1556.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,908.1,
HC 2.0MM T1 LC-DCP PLATE 4 HOLES 24MM,Sx0000449.931,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,948,853.2,900.6,,,853.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,739.44,,,739.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.2,,,789.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.2,,,483.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.2,,,789.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.52,,,483.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,853.2,,,853.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,910.08,,,910.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,696.78,,,739.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.17,,,739.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,872.16,,,872.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.52,,,483.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,805.8,,,805.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,900.6,,,853.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.2,,,900.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.52,,,464.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,739.44,910.08,
HC DRILL BIT LOCKING SHORT 3.1 X 216MM,Sx00000705031,CDM,,,270,RC,,,,BOTH,,,948.96,854.06,901.51,,,854.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.19,,,740.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,854.06,,,789.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,854.06,,,483.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,854.06,,,789.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.99,,,483.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.06,,,854.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,911,,,911,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,697.49,,,740.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,469.64,,,740.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,873.04,,,873.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.99,,,483.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,806.62,,,806.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,901.51,,,854.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,854.06,,,901.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,464.99,,,464.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,740.19,911,
HC CASIRIVIMAB IMDEVIMAB INFUSION OR INJECTION ADMIN M0243,Px00026000002,CDM,M0243,CPT,260,RC,,,,BOTH,,,950,855,902.5,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741,,,741,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,790.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,484.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,790.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,484.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912,,,912,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.25,,,741,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.16,,,741,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,874,,,874,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,484.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,807.5,,,807.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,902.5,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,902.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,465.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,741,912,
HC SOTROVIMAB INFUSION ADMIN M0247,Px00026000007,CDM,M0247,CPT,260,RC,,,,BOTH,,,950,855,902.5,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741,,,741,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,790.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,484.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,790.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,484.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912,,,912,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.25,,,741,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.16,,,741,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,874,,,874,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,484.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,807.5,,,807.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,902.5,,,855,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855,,,902.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.5,,,465.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,741,912,
HC SCREW AUTOFIX 4.0 X 36MM IMPL,Sx000141-4036,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,951,855.9,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741.78,,,741.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,484.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912.96,,,912.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.99,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.65,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,874.92,,,874.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,808.35,,,808.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,903.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,465.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,741.78,912.96,
HC SCREW AUTOFIX 4.0 X 46MM IMPL,Sx000141-4046,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,951,855.9,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741.78,,,741.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,484.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912.96,,,912.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.99,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.65,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,874.92,,,874.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,808.35,,,808.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,903.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,465.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,741.78,912.96,
HC SCREW AUTOFIX 4.0 X 34MM IMPL,Sx000141-4034,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,951,855.9,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,741.78,,,741.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,484.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,791.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912.96,,,912.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,698.99,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,470.65,,,741.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,874.92,,,874.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,484.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,808.35,,,808.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,903.45,,,855.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.9,,,903.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,465.99,,,465.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,741.78,912.96,
HC PR 49600 RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE CDM,Px00097513035,CDM,49600,CPT,975,RC,,,,BOTH,,,1764,1587.6,987.84,,,1587.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1002.91,,,1375.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1102.5,,,1468.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1102.5,,,898.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1102.5,,,1468.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,823.77,,,898.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,869.71,,,1587.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,970.2,,,1693.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,1375.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1005.48,,,1622.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,737.81,,,898.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1005.48,,,1499.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,987.84,,,1587.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,914.85,,,1675.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,914.85,
HC PR 27654 REPAIR OF ACHILLES TENDON,Px00097512300,CDM,27654,CPT,975,RC,,,,BOTH,,,1715,1543.5,960.4,,,1543.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,910.7,,,1337.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1071.88,,,1414.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1071.88,,,822.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1071.88,,,1414.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,821.71,,,822.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,844.7,,,1543.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,943.25,,,962.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.63,,,1337.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,49.63,,,1337.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,977.55,,,1577.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,735.97,,,873.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,977.55,,,1457.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,960.4,,,1543.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,915.75,,,1629.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,49.63,,,49.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,49.63,915.75,
HC PATELLA REAMING SYSTEM REAMING BLADE W/HOLE 41MM DIA,Sx00-5979-095,CDM,,,270,RC,,,,BOTH,,,960,810,912,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.8,,,748.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,799.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,489.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,799.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,489.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,864,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.6,,,921.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,705.6,,,748.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,475.1,,,748.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,883.2,,,883.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,489.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816,,,816,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,912,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,470.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,748.8,921.6,
HC T-PLATE 2.3 M HANDLOCK NAR 6H PROFYLE,Sx00057-15340,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,960,864,912,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,748.8,,,748.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,799.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,489.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,799.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,489.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,864,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.6,,,921.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,705.6,,,748.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,475.1,,,748.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,883.2,,,883.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,489.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816,,,816,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,912,,,864,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864,,,912,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,470.4,,,470.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,748.8,921.6,
HC PR 28296 CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT,Px00097511354,CDM,28296,CPT,975,RC,,,,BOTH,,,2170,1953,1215.2,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,650.6,,,1692.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1806.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1806.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,590.67,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,615.54,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1193.5,,,2083.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,513.63,,,1692.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,513.63,,,1692.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1236.9,,,1996.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,529.04,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1236.9,,,1844.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1215.2,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,925.2,,,2061.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,513.63,,,513.63,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,513.63,925.2,
HC ANESTHESIA GEN 15 MIN CDM,Px00037010122,CDM,,,370,RC,,,,BOTH,,,968,871.2,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.04,,,755.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,493.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.28,,,929.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.48,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.06,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,890.56,,,890.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.8,,,822.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,919.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,474.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,755.04,929.28,
HC ANESTHESIA IV GA 15 MIN CDM,Px00037010124,CDM,,,370,RC,,,,BOTH,,,968,871.2,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.04,,,755.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,493.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.28,,,929.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.48,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.06,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,890.56,,,890.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.8,,,822.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,919.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,474.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,755.04,929.28,
HC ANESTHESIA MAC 15 MIN CDM,Px00037010126,CDM,,,370,RC,,,,BOTH,,,968,871.2,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.04,,,755.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,493.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.28,,,929.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.48,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.06,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,890.56,,,890.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.8,,,822.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,919.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,474.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,755.04,929.28,
HC ANESTHESIA REGIONAL 15 MIN CDM,Px00037010130,CDM,,,370,RC,,,,BOTH,,,968,871.2,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,755.04,,,755.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,493.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,805.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.28,,,929.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,711.48,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,479.06,,,755.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,890.56,,,890.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,493.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,822.8,,,822.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.6,,,871.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,871.2,,,919.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,474.32,,,474.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,755.04,929.28,
HC PR 23515 OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,Px00097511303,CDM,23515,CPT,975,RC,,,,BOTH,,,1707,1536.3,955.92,,,1536.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,926.59,,,1331.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1066.88,,,1410.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1066.88,,,829.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1066.88,,,1410.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,826.62,,,829.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,856.79,,,1536.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,938.85,,,976.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,345.1,,,1331.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,345.1,,,1331.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,972.99,,,1570.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,740.36,,,869.89,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,972.99,,,1450.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,955.92,,,1536.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,931.05,,,1621.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,345.1,,,345.1,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,345.1,931.05,
HC INTRA ACUITY PER HR CLASS 2,Px00072010071,CDM,,,720,RC,,,,BOTH,,,970,603.9,921.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,756.6,,,627.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,873,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,873,,,410.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,873,,,670.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.3,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,873,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,931.2,,,772.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,712.95,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,475.3,,,627.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.4,,,740.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.3,,,410.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,824.5,,,684.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.5,,,724.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,873,,,764.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,475.3,,,475.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,756.6,931.2,
HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH,Px00097510819,CDM,47563,CPT,975,RC,,,,BOTH,,,1713,1541.7,959.28,,,1541.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,978,,,1336.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1070.63,,,1409.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1070.63,,,807.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1070.63,,,1409.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,804.2,,,807.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,850.77,,,1541.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,942.15,,,964.73,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,1336.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,1336.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,976.41,,,1575.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,720.28,,,872.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,976.41,,,1456.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,959.28,,,1541.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,931.95,,,1627.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,147.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,147.55,931.95,
HC PR ED 49451 REPLACE DUOD/JEJ TUBE PERC CDM,Px00098110115,CDM,49451,CPT,981,RC,,,,OUTPATIENT,,,2789,2510.1,1561.84,,,2510.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,118.06,,,2175.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1743.13,,,2321.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1743.13,,,1421.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1743.13,,,2321.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,96.57,,,1421.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,108.34,,,2510.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1533.95,,,2677.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,2175.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,2175.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1589.73,,,2565.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,86.49,,,1421.27,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1589.73,,,2370.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1561.84,,,2510.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.75,,,2649.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,83.97,,,83.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,83.97,933.75,
HC PR 45398 COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) [45398] CDM,Px00097500052,CDM,45398,CPT,975,RC,,,,BOTH,,,549,494.1,307.44,,,494.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.03,,,428.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,343.13,,,452.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,343.13,,,261.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,343.13,,,452.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,258.93,,,261.34,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,284.82,,,494.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,301.95,,,549,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,428.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,428.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,312.93,,,505.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,231.91,,,279.77,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,312.93,,,466.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,307.44,,,494.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,935.55,,,521.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.16,,,225.16,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,225.16,935.55,
HC FLIP CUTTER II 10.0MM,SxAR-1204AF-1,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 6.5MM,SxAR-1204AF-6,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 9.5MM,SxAR-1204AF-9,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 11.0MM,SxAR-1204AF-1,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 8.5MM,SxAR-1204AF-8,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 9.0MM,SxAR-1204AF-9,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC FLIP CUTTER II 10.5MM,SxAR-1204AF-1,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC AIRWAY LMA CLASSIC NO 3 REUSABE TO 40 TIMES,Sx00000010130,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC AIRWAY LMA CLASSIC NO 5 REUSABLE TO 40 TIMES,Sx00000010150,CDM,,,270,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC SUTURE ANCHOR MINI BC S-TAK 2.4X8.5MM,SxAR-1322BCNF,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,975,877.5,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.5,,,760.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,496.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,811.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,716.63,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,482.53,,,760.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,897,,,897,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,496.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,828.75,,,828.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.25,,,877.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,877.5,,,926.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,477.75,,,477.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,760.5,936,
HC DRILL BIT AO DIA 2.0X135MM SCALED,Sx00000703896,CDM,,,270,RC,,,,BOTH,,,978,880.2,929.1,,,880.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.84,,,762.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.2,,,814.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.2,,,498.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.2,,,814.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.22,,,498.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,880.2,,,880.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,938.88,,,938.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,718.83,,,762.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,484.01,,,762.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,899.76,,,899.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.22,,,498.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.3,,,831.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.1,,,880.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.2,,,929.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,479.22,,,479.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,762.84,938.88,
HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM,Px00045010372,CDM,12031,CPT,450,RC,,,,OUTPATIENT,,,984,700.2,934.8,,,770.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,767.52,,,667.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,885.6,,,712.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,885.6,,,436.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,885.6,,,712.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.16,,,436.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,885.6,,,770.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,944.64,,,821.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.24,,,667.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,486.98,,,667.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,905.28,,,787.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.16,,,436.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,836.4,,,727.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.8,,,770.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,885.6,,,813.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,482.16,,,482.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,767.52,944.64,
HC AIRWAY LMA CLASSIC NO 2.5 REUSABLE TO 40 TIMES,Sx00000010125,CDM,,,270,RC,,,,BOTH,,,986.21,887.59,936.9,,,887.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.24,,,769.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.59,,,820.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.59,,,502.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.59,,,820.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.24,,,502.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.59,,,887.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,946.76,,,946.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,724.86,,,769.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.08,,,769.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.31,,,907.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.24,,,502.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.28,,,838.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,887.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,887.59,,,936.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.24,,,483.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,769.24,946.76,
HC LOCKING SCREW T8 FULL THREAD 2.4MM L14MM,Sx00000656014,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,987,888.3,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.86,,,769.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,502.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,947.52,,,947.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.47,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,908.04,,,908.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.95,,,838.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,937.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,483.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,769.86,947.52,
HC LOCKING SCREW T8 FULL THREAD 2.4MM L18MM,Sx00000656018,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,987,888.3,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.86,,,769.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,502.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,947.52,,,947.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.47,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,908.04,,,908.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.95,,,838.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,937.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,483.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,769.86,947.52,
HC LOCKING SCREW T8 FULL THREAD 2.4MM L20MM,Sx00000656020,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,987,888.3,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.86,,,769.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,502.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,947.52,,,947.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.47,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,908.04,,,908.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.95,,,838.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,937.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,483.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,769.86,947.52,
HC LOCKING SCREW T8 FULL THREAD 2.4MM L16MM,Sx00000656016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,987,888.3,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,769.86,,,769.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,502.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,821.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,947.52,,,947.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,488.47,,,769.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,908.04,,,908.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,502.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.95,,,838.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.65,,,888.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,888.3,,,937.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,483.63,,,483.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,769.86,947.52,
HC PR 26480 TRANSPLANT HAND TENDON,Px00097512176,CDM,26480,CPT,975,RC,,,,BOTH,,,1894,1704.6,1060.64,,,1704.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1062.34,,,1477.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1183.75,,,1576.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1183.75,,,965.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1183.75,,,1576.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,824,,,965.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,887.72,,,1704.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1041.7,,,1818.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,1477.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,1477.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1079.58,,,1742.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,738.08,,,965.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1079.58,,,1609.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1060.64,,,1704.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,950.4,,,1799.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,78.2,,,78.2,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,78.2,950.4,
HC FLUENT DISPOSABLE PACK FLUID MANAGEMENT PRODUCT,Sx0000FLT-112,CDM,,,270,RC,,,,BOTH,,,990,891,940.5,,,891,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.2,,,772.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891,,,824.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891,,,504.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891,,,824.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.1,,,504.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,891,,,891,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,950.4,,,950.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.65,,,772.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,489.95,,,772.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,910.8,,,910.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.1,,,504.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,841.5,,,841.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,891,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.1,,,485.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,772.2,950.4,
HC PERQ DEVICE LOC BREAST 1ST IMAG,Px00036111189,CDM,19281,CPT,361,RC,,,,BOTH,,,991,891.9,941.45,,,891.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,772.98,,,772.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891.9,,,824.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891.9,,,505.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891.9,,,824.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.59,,,505.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,891.9,,,891.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,951.36,,,951.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,728.39,,,772.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,490.45,,,772.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,911.72,,,911.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.59,,,505.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,842.35,,,842.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.45,,,891.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,891.9,,,941.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,485.59,,,485.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,772.98,951.36,
HC CT HEAD/BRAIN WO & W CONTRAST,Px00035110012,CDM,70470,CPT,350,RC,,,,BOTH,,,996,896.4,946.2,,,896.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,776.88,,,776.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.4,,,829.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.4,,,507.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.4,,,829.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.04,,,507.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,896.4,,,896.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,956.16,,,956.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.06,,,776.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,492.92,,,776.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,916.32,,,916.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.04,,,507.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,846.6,,,846.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,946.2,,,896.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.4,,,946.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,488.04,,,488.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,776.88,956.16,
CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML,Rx00009085605,CDM,,,250,RC,00009-0856-05,NDC,,BOTH,1,ML,997.96,898.16,948.06,,,948.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,778.41,,,778.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,898.16,,,898.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,898.16,,,898.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,898.16,,,898.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,489,,,489,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,898.16,,,898.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,958.04,,,958.04,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,733.5,,,733.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,493.89,,,493.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,918.12,,,918.12,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,489,,,489,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,848.27,,,848.27,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,948.06,,,948.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,898.16,,,898.16,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,489,,,489,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,778.41,958.04,
HC PR 23430 REPAIR TENODESIS OF BICEP,Px00097510467,CDM,23430,CPT,975,RC,,,,BOTH,,,1765,1588.5,988.4,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,956.73,,,1376.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,1458.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,855.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,1458.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,851.72,,,855.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,885.73,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,970.75,,,1013.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,1376.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,1376.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1006.05,,,1623.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,762.85,,,899.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1006.05,,,1500.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.4,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,964.35,,,1676.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,47.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,47.95,964.35,
HC PR 23430 ASSIST REPAIR BICEPS TENDON,Px00097510479,CDM,23430,CPT,975,RC,,,,BOTH,,,1765,1588.5,988.4,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,956.73,,,1376.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,1458.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,855.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.13,,,1458.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,851.72,,,855.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,885.73,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,970.75,,,1013.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,1376.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,1376.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1006.05,,,1623.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,762.85,,,899.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1006.05,,,1500.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.4,,,1588.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,964.35,,,1676.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,47.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,47.95,964.35,
HC ACL TIGHTROPE W/FIBERTAG ABS,Sx0AR-1588TNT,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1005,904.5,954.75,,,904.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.9,,,783.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,836.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,512.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,836.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,492.45,,,512.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,904.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,964.8,,,964.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,738.68,,,783.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,497.37,,,783.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,924.6,,,924.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,492.45,,,512.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,854.25,,,854.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,954.75,,,904.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,904.5,,,954.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,492.45,,,492.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,783.9,964.8,
HC CT UPPER EXTREMITY WO CONTRAST,Px00035210029,CDM,73200,CPT,350,RC,,,,BOTH,,,1007,906.3,956.65,,,906.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,785.46,,,785.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,838.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,513.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,838.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.43,,,513.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,906.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,966.72,,,966.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.15,,,785.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,498.36,,,785.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,926.44,,,926.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.43,,,513.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,855.95,,,855.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,956.65,,,906.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,906.3,,,956.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.43,,,493.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,785.46,966.72,
HC DRILL BIT 2.6MM X 220MM AO FITTING,Sx00000703824,CDM,,,270,RC,,,,BOTH,,,1008,907.2,957.6,,,907.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,786.24,,,786.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.2,,,839.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.2,,,513.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.2,,,839.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.92,,,513.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.2,,,907.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,967.68,,,967.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,740.88,,,786.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,498.86,,,786.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,927.36,,,927.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.92,,,513.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,856.8,,,856.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,957.6,,,907.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.2,,,957.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,493.92,,,493.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,786.24,967.68,
HC CT LUMBAR SPINE WO CONTRAST,Px00035210014,CDM,72131,CPT,350,RC,,,,BOTH,,,1010,909,959.5,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,787.8,,,787.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,840.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,514.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,840.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,514.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,909,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,969.6,,,969.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,787.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.85,,,787.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,929.2,,,929.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,514.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.5,,,858.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.5,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,959.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,494.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,787.8,969.6,
HC CT LOWER EXTREMITY WO CONTRAST,Px00035210030,CDM,73700,CPT,350,RC,,,,BOTH,,,1010,909,959.5,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,787.8,,,787.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,840.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,514.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,840.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,514.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,909,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,969.6,,,969.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,787.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,499.85,,,787.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,929.2,,,929.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,514.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,858.5,,,858.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.5,,,909,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909,,,959.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,494.9,,,494.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,787.8,969.6,
HC PR 27524 TREAT KNEECAP FRACTURE,Px00096910767,CDM,27524,CPT,983,RC,,,,BOTH,,,1786,1607.4,1000.16,,,1607.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,966.55,,,1393.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1116.25,,,1486.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1116.25,,,910.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1116.25,,,1486.67,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,749.59,,,910.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,895.26,,,1607.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,982.3,,,1714.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,312.75,,,1393.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,312.75,,,1393.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1018.02,,,1643.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,772.08,,,910.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1018.02,,,1518.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1000.16,,,1607.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,973.35,,,1696.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,312.75,,,312.75,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,312.75,973.35,
HC CT CHEST SPINE WO CONTRAST,Px00035210011,CDM,72128,CPT,350,RC,,,,BOTH,,,1016,914.4,965.2,,,914.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,792.48,,,792.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.4,,,845.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.4,,,517.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.4,,,845.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.84,,,517.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,914.4,,,914.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,975.36,,,975.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,746.76,,,792.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,502.82,,,792.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,934.72,,,934.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.84,,,517.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,863.6,,,863.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,965.2,,,914.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.4,,,965.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,497.84,,,497.84,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,792.48,975.36,
HC CT NECK SPINE WO CONTRAST,Px00035210008,CDM,72125,CPT,350,RC,,,,BOTH,,,1021,918.9,969.95,,,918.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,796.38,,,796.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,918.9,,,849.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,918.9,,,520.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,918.9,,,849.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.29,,,520.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,918.9,,,918.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.16,,,980.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,750.44,,,796.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,505.29,,,796.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,939.32,,,939.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.29,,,520.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,867.85,,,867.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,969.95,,,918.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,918.9,,,969.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,500.29,,,500.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,796.38,980.16,
HC ED FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE CDM,Px00045010949,CDM,10021,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,96.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM,Px00045010031,CDM,10160,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,129.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED REMOVE FOREIGN BODY SIMPLE CDM,Px00045010313,CDM,10120,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,139.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM,Px00045010310,CDM,10061,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,690.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,240.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED REPAIR SPRFCL WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN TRNK EXTR H CDM,Px00045010358,CDM,12005,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM,Px00045010373,CDM,12032,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM,Px00045010374,CDM,12034,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM,Px00045010375,CDM,12035,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM,Px00045010378,CDM,12041,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM,Px00045010380,CDM,12042,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR FACE/MM <2.5 CM CDM,Px00045010385,CDM,12051,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM,Px00045010386,CDM,12052,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC ED INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM,Px00045010387,CDM,12053,CPT,450,RC,,,,OUTPATIENT,,,1032,733.5,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.96,,,699.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,457.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,746.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.72,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,758.52,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,510.74,,,699.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.44,,,825.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,457.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,877.2,,,762.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,980.4,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.8,,,852.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,505.68,,,505.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,804.96,990.72,
HC DRILL BIT AO DIA 2.6MM X 135MM SCALED,Sx00000703691,CDM,,,270,RC,,,,BOTH,,,1035,931.5,983.25,,,931.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,807.3,,,807.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,931.5,,,861.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,931.5,,,527.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,931.5,,,861.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,527.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,931.5,,,931.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.73,,,807.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,512.22,,,807.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,952.2,,,952.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,527.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,879.75,,,879.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,983.25,,,931.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,931.5,,,983.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,507.15,,,507.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,807.3,993.6,
HC ED REPAIR SPRFCL WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TRNK EXTR HND CDM,Px00045010359,CDM,12006,CPT,450,RC,,,,OUTPATIENT,,,1038,738.9,986.1,,,812.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,809.64,,,704.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,751.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,460.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,751.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.62,,,460.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,812.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,996.48,,,866.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.93,,,704.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,513.71,,,704.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,954.96,,,830.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.62,,,460.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,882.3,,,767.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,986.1,,,812.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,857.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.62,,,508.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,809.64,996.48,
HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,Px00092110019,CDM,93978,CPT,921,RC,,,,BOTH,,,1038,934.2,986.1,,,934.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,809.64,,,809.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,864.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,528.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,864.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,534.67,,,528.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,934.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,996.48,,,996.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.93,,,809.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,508.62,,,809.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,954.96,,,954.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.38,,,528.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,882.3,,,882.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,986.1,,,934.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.2,,,986.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,508.62,,,508.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,809.64,996.48,
HC ED REPAIR SUPERFICIAL WOUND(S) 12.6-20.0CM FACE ERS EYLD NSE LPS MUC CDM,Px00045010365,CDM,12016,CPT,450,RC,,,,OUTPATIENT,,,1040,739.8,988,,,813.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.2,,,705.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,752.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,460.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,752.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.6,,,460.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,936,,,813.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,998.4,,,867.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.4,,,705.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,514.7,,,705.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,956.8,,,831.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.6,,,460.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,884,,,768.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988,,,813.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,858.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,509.6,,,509.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,811.2,998.4,
HC ED INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM,Px00045010388,CDM,12054,CPT,450,RC,,,,OUTPATIENT,,,1041,740.7,988.95,,,814.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.98,,,705.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,753.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,461.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,753.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.09,,,461.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,814.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999.36,,,868.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.14,,,705.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,515.19,,,705.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,957.72,,,832.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.09,,,461.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,884.85,,,769.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988.95,,,814.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936.9,,,859.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,510.09,,,510.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,811.98,999.36,
HC PR 27814 OPEN TREATMENT OF ANKLE FRACTURE,Px00097510963,CDM,27814,CPT,975,RC,,,,BOTH,,,1819,1637.1,1018.64,,,1637.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,982.74,,,1418.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1136.88,,,1501.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1136.88,,,876.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1136.88,,,1501.59,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,871.88,,,876.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,917.84,,,1637.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1000.45,,,1048.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,1418.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,1418.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.83,,,1673.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,780.9,,,926.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.83,,,1546.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1018.64,,,1637.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,999.44,,,1728.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,435.55,,,435.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,435.55,999.44,
HC CT SOFT TISSUE NECK W CONTRAST,Px00035010008,CDM,70491,CPT,350,RC,,,,BOTH,,,1043,938.7,990.85,,,938.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,813.54,,,813.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,938.7,,,868.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,938.7,,,531.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,938.7,,,868.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.07,,,531.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.7,,,938.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1001.28,,,1001.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,766.61,,,813.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.18,,,813.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,959.56,,,959.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.07,,,531.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,886.55,,,886.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.85,,,938.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,938.7,,,990.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.07,,,511.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,813.54,1001.28,
HC PR 32550 INDWELL TUNN PLEURL CATH,Px00096910358,CDM,32550,CPT,983,RC,,,,BOTH,,,1971,1773.9,1103.76,,,1773.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,273.07,,,1537.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1231.88,,,1640.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1231.88,,,1004.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1231.88,,,1640.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.49,,,1004.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.04,,,1773.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1084.05,,,1892.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,1537.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,1537.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1123.47,,,1813.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,200.17,,,1004.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1123.47,,,1675.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.76,,,1773.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1001.69,,,1872.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,194.34,,,194.34,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,194.34,1001.69,
HC LOCKING SCREW T10 3.5X16MM,Sx00000614616,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1044,939.6,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,814.32,,,814.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,532.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.24,,,1002.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,767.34,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.68,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,960.48,,,960.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.4,,,887.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,991.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,511.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,814.32,1002.24,
HC LOCKING SCREW T10 3.5X18MM,Sx00000614618,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1044,939.6,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,814.32,,,814.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,532.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.24,,,1002.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,767.34,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.68,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,960.48,,,960.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.4,,,887.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,991.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,511.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,814.32,1002.24,
HC LOCKING SCREW T10 3.5X22MM,Sx00000614622,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1044,939.6,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,814.32,,,814.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,532.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.24,,,1002.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,767.34,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.68,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,960.48,,,960.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.4,,,887.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,991.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,511.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,814.32,1002.24,
HC LOCKING SCREW T10 3.5X20MM,Sx00000614620,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1044,939.6,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,814.32,,,814.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,532.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,869.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.24,,,1002.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,767.34,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,516.68,,,814.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,960.48,,,960.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,532.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.4,,,887.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,991.8,,,939.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.6,,,991.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,511.56,,,511.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,814.32,1002.24,
HC ED REMOVAL OF NAIL BED CDM,Px00045010351,CDM,11750,CPT,450,RC,,,,OUTPATIENT,,,1045,743.4,992.75,,,818.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.1,,,709.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,699.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,699.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.05,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,818.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1003.2,,,234.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,768.08,,,709.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,517.17,,,709.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.4,,,836.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.05,,,463.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,888.25,,,772.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.75,,,818.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,940.5,,,863.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.05,,,512.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,815.1,1003.2,
HC CT THORAX W CONTRAST,Px00035210003,CDM,71260,CPT,350,RC,,,,BOTH,,,1250,941.4,993.7,,,1125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.88,,,975,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.4,,,1037.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.4,,,637.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.4,,,1037.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.54,,,637.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,941.4,,,1125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1004.16,,,1200,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,768.81,,,975,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,517.67,,,975,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,962.32,,,1150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.54,,,637.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,889.1,,,1062.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.7,,,1125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.4,,,1187.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,512.54,,,612.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,815.88,1004.16,
HC TRIM-IT DRILL PIN 1.5 X 100MM,Sx00AR-4151DS,CDM,,,270,RC,,,,BOTH,,,1050,945,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819,,,819,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,535.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,945,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008,,,1008,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.65,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,966,,,966,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.5,,,892.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,997.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,514.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,819,1008,
HC TRIM-IT DRILL PIN 2.0 X 100MM,Sx00AR-4152DS,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1050,945,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819,,,819,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,535.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,945,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008,,,1008,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.65,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,966,,,966,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.5,,,892.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,997.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,514.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,819,1008,
HC ACL TIGHTROPE RT,Sx00AR-1588RT,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1050,945,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819,,,819,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,535.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,945,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008,,,1008,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.65,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,966,,,966,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.5,,,892.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,997.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,514.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,819,1008,
HC BUTTON DOG BONE,Sx0000AR-2270,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1050,945,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819,,,819,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,535.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,945,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008,,,1008,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.65,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,966,,,966,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.5,,,892.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,997.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,514.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,819,1008,
HC SCREW COMPR FT 2.5 MICRO 18MM LGTH,SxAR-8725-18H,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1050,945,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,819,,,819,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,535.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,874.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,945,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008,,,1008,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.65,,,819,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,966,,,966,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,535.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,892.5,,,892.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,997.5,,,945,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945,,,997.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,514.5,,,514.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,819,1008,
HC DRILL BIT NON LOCKING SHORT 2.5X216MM,Sx00000705025,CDM,,,270,RC,,,,BOTH,,,1054.92,949.43,1002.17,,,949.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,822.84,,,822.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.43,,,878.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.43,,,537.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.43,,,878.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,516.91,,,537.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.43,,,949.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1012.72,,,1012.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,775.37,,,822.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,522.08,,,822.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,970.53,,,970.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,516.91,,,537.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,896.68,,,896.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.17,,,949.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.43,,,1002.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,516.91,,,516.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,822.84,1012.72,
HC PR 29855 TIBIAL ARTHROSCOPY/SURGERY,Px00097512357,CDM,29855,CPT,975,RC,,,,BOTH,,,1850,1665,1036,,,1665,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1001.88,,,1443,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1156.25,,,1539.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1156.25,,,942.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1156.25,,,1539.94,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,892.23,,,942.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,933.42,,,1665,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1017.5,,,1776,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1443,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1443,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1054.5,,,1702,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,799.13,,,942.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1054.5,,,1572.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036,,,1665,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1012.94,,,1757.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,1012.94,
HC PR 45382 COLONOSCOPY/CONTROL BLEEDING,Px00097510770,CDM,45382,CPT,975,RC,,,,BOTH,,,1647,1482.3,922.32,,,1482.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,350.73,,,1284.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1029.38,,,1370.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1029.38,,,839.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1029.38,,,1370.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,285.29,,,839.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,315.16,,,1482.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,905.85,,,1581.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.08,,,1284.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,248.08,,,1284.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,938.79,,,1515.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.52,,,839.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,938.79,,,1399.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,922.32,,,1482.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1013.39,,,1564.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,248.08,,,248.08,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,248.08,1013.39,
HC MESH VICRYL WOVEN 6X6 VWMM,Sx0000000VWMM,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1061.92,955.73,1008.82,,,955.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,828.3,,,828.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.73,,,883.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.73,,,541.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.73,,,883.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,520.34,,,541.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,955.73,,,955.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1019.44,,,1019.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,780.51,,,828.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,525.54,,,828.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,976.97,,,976.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,520.34,,,541.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,902.63,,,902.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1008.82,,,955.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.73,,,1008.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,520.34,,,520.34,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,828.3,1019.44,
HC PERC INSERT KIT FOR 3.0MM KNOTLESS ST,Sx00AR-1938PK,CDM,,,270,RC,,,,BOTH,,,1065,958.5,1011.75,,,958.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.7,,,830.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,958.5,,,886.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,958.5,,,542.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,958.5,,,886.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.85,,,542.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,958.5,,,958.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1022.4,,,1022.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,782.78,,,830.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,527.07,,,830.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,979.8,,,979.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.85,,,542.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,905.25,,,905.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1011.75,,,958.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,958.5,,,1011.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,521.85,,,521.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,830.7,1022.4,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML,Rx13533080021,CDM,J1561,HCPCS,636,RC,13533080021,NDC,,BOTH,50,ML,1067.95,961.16,1014.55,,,961.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833,,,833,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.16,,,888.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.16,,,544.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.16,,,888.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.3,,,544.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.16,,,961.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.23,,,1025.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.94,,,833,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,523.3,,,833,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.51,,,982.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.3,,,544.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.76,,,907.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.55,,,961.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.16,,,1014.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.3,,,523.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833,1025.23,
HC LOCKING SCREW 3.5X18MM,Sx00058803518,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC LOCKING SCREW 3.5X20MM,Sx00058803520,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC LOCKING SCREW 3.5X24MM,Sx00058803524,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC 3DSi POLYAXIAL LOCKING SCREW 2.7MM ORTHOLOC 18MM,Sx00040232718,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC 3DSi POLYAXIAL LOCKING SCREW 2.7MM ORTHOLOC 22MM,Sx00040232722,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC 3DSi POLYAXIAL LOCKING SCREW 2.7MM ORTHOLOC 24MM,Sx00050232724,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1068,961.2,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,833.04,,,833.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,889,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.28,,,1025.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.98,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.55,,,833.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.56,,,982.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,544.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,907.8,,,907.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.6,,,961.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.2,,,1014.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,523.32,,,523.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,833.04,1025.28,
HC DRILL TWIST 2.7MM CANN W/AO,Sx00000702449,CDM,,,270,RC,,,,BOTH,,,1076.19,968.57,1022.38,,,968.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,839.43,,,839.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.57,,,895.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.57,,,548.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.57,,,895.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.33,,,548.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,968.57,,,968.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1033.14,,,1033.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791,,,839.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,532.61,,,839.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,990.09,,,990.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.33,,,548.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,914.76,,,914.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1022.38,,,968.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.57,,,1022.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,527.33,,,527.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,839.43,1033.14,
HC SCREW HEX 3.5MM X 33MM,Sx00-5901-035,CDM,,,270,RC,,,,BOTH,,,1080,972,1026,,,972,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,842.4,,,842.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,972,,,898.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,972,,,550.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,972,,,898.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,550.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,972,,,972,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1036.8,,,1036.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,842.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,534.49,,,842.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,550.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,918,,,918,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1026,,,972,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,972,,,1026,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,529.2,,,529.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,842.4,1036.8,
DAPTOMYCIN FOR IV SOLN 500 MG,Rx67919001201,CDM,J0878,HCPCS,636,RC,67919001201,NDC,,BOTH,500,ME,1090.71,981.64,1036.17,,,1036.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,850.75,,,850.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,981.64,,,981.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,981.64,,,981.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,981.64,,,981.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,534.45,,,534.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,981.64,,,981.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1047.08,,,1047.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,801.67,,,801.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,534.45,,,534.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1003.45,,,1003.45,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,534.45,,,534.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,927.1,,,927.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1036.17,,,1036.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,981.64,,,981.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,534.45,,,534.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,850.75,1047.08,
HC LOCKING SCREW FULL THRD 2.7MM T10 L12MM,Sx00000657012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1098,988.2,1043.1,,,988.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,856.44,,,856.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988.2,,,913.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988.2,,,559.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988.2,,,913.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.02,,,559.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,988.2,,,988.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1054.08,,,1054.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,807.03,,,856.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,543.4,,,856.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1010.16,,,1010.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.02,,,559.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,933.3,,,933.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1043.1,,,988.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,988.2,,,1043.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,538.02,,,538.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,856.44,1054.08,
DAPTOMYCIN FOR IV SOLN 500 MG,Rx67919001202,CDM,J0878,HCPCS,636,RC,67919001202,NDC,,BOTH,500,ME,1098.84,988.96,1043.9,,,1043.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,857.1,,,857.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,988.96,,,988.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,988.96,,,988.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,988.96,,,988.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,538.43,,,538.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,988.96,,,988.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1054.89,,,1054.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,807.65,,,807.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,538.43,,,538.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1010.93,,,1010.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,538.43,,,538.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,934.01,,,934.01,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1043.9,,,1043.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,988.96,,,988.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,538.43,,,538.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,857.1,1054.89,
"HC SCREW CAPTURING ROD, STRAIGHT HANDLE",Sx0000477-000,CDM,,,270,RC,,,,BOTH,,,1102.5,992.25,1047.38,,,992.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,859.95,,,859.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,917.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,561.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,917.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,561.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,992.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1058.4,,,1058.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810.34,,,859.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,545.63,,,859.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,1014.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,561.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,937.13,,,937.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.38,,,992.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,1047.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,540.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,859.95,1058.4,
HC COMPRESSION FT SCREW 3.5MINI 32MM LENGTH,SxAR-8730-32H,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1102.5,992.25,1047.38,,,992.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,859.95,,,859.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,917.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,561.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,917.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,561.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,992.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1058.4,,,1058.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,810.34,,,859.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,545.63,,,859.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,1014.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,561.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,937.13,,,937.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.38,,,992.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,992.25,,,1047.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.23,,,540.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,859.95,1058.4,
HC PR 59409 VAGINAL DELIVERY ONLY,Px00097511360,CDM,59409,CPT,975,RC,,,,BOTH,,,1929,1736.1,1080.24,,,1736.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,870.23,,,1504.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1205.63,,,1605.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1205.63,,,983.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1205.63,,,1605.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,876.42,,,983.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,962.49,,,1736.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1060.95,,,1851.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,1504.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,1504.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1099.53,,,1774.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,784.96,,,983.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1099.53,,,1639.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1080.24,,,1736.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1059.75,,,1832.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,141.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.27,1059.75,
HC 6.5 32MM X 55MM EXPLANT,Sx000121-6055,CDM,,,270,RC,,,,BOTH,,,1104,993.6,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,861.12,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,562.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1059.84,,,1059.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.44,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.37,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1015.68,,,1015.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.4,,,938.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,1048.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,861.12,1059.84,
HC SCREW 6.5 x 90MM,Sx000120-6090,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1104,993.6,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,861.12,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,562.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1059.84,,,1059.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.44,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.37,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1015.68,,,1015.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.4,,,938.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,1048.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,861.12,1059.84,
HC 6.5 32MM X 75MM IMPLANT,Sx000121-6075,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1104,993.6,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,861.12,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,562.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1059.84,,,1059.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.44,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.37,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1015.68,,,1015.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.4,,,938.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,1048.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,861.12,1059.84,
HC SCREW CANNULATED 6.5 X 35 MM 16MM THRD IMPL,Sx000120-6035,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1104,993.6,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,861.12,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,562.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1059.84,,,1059.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.44,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.37,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1015.68,,,1015.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.4,,,938.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,1048.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,861.12,1059.84,
HC 6.5 32MM X 80MM IMPLANT,Sx000121-6080,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1104,993.6,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,861.12,,,861.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,562.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,918.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1059.84,,,1059.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,811.44,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,546.37,,,861.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1015.68,,,1015.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,562.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.4,,,938.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.8,,,993.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,993.6,,,1048.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,540.96,,,540.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,861.12,1059.84,
"HC PR 25608 OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG [25608] CDM",Px00097500045,CDM,25608,CPT,975,RC,,,,BOTH,,,1957,1761.3,1095.92,,,1761.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1063.64,,,1526.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1223.13,,,1618.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1223.13,,,954.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1223.13,,,1618.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,952.89,,,954.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.58,,,1761.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1076.35,,,1112.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,1526.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,1526.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1115.49,,,1800.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,853.46,,,997.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1115.49,,,1663.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1095.92,,,1761.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1063.35,,,1859.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,519.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,519.48,1063.35,
HC PSN 2.5MM FEMALE HEX SCREW 25MM,Sx42-5099-025,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1110,945,1054.5,,,999,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,865.8,,,865.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999,,,923.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999,,,565.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999,,,923.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.9,,,565.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,999,,,999,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1065.6,,,1065.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.85,,,865.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,549.34,,,865.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1021.2,,,1021.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.9,,,565.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,943.5,,,943.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1054.5,,,999,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999,,,1054.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,543.9,,,543.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,865.8,1065.6,
HC PR 25447 REPAIR WRIST JOINT(S),Px00096910712,CDM,25447,CPT,975,RC,,,,BOTH,,,1964,1767.6,1099.84,,,1767.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1069.52,,,1531.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1227.5,,,1624.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1227.5,,,958.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1227.5,,,1624.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,920.66,,,958.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,987.04,,,1767.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1080.2,,,1115.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.97,,,1531.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,69.97,,,1531.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1119.48,,,1806.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,824.59,,,1000.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1119.48,,,1669.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1099.84,,,1767.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1066.95,,,1865.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.97,,,69.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,69.97,1066.95,
HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,Px00092110002,CDM,93880,CPT,921,RC,,,,BOTH,,,1113,1001.7,1057.35,,,1001.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,868.14,,,868.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1001.7,,,926.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1001.7,,,567.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1001.7,,,926.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,573.31,,,567.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1001.7,,,1001.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1068.48,,,1068.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,818.06,,,868.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,545.37,,,868.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1023.96,,,1023.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,567.63,,,567.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,946.05,,,946.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1057.35,,,1001.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1001.7,,,1057.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,545.37,,,545.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,868.14,1068.48,
HC PR 26123 RELEASE PALM CONTRACTURE PARTIAL,Px00096910729,CDM,26123,CPT,983,RC,,,,BOTH,,,1976,1778.4,1106.56,,,1778.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1079.67,,,1541.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1235,,,1644.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1235,,,1006.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1235,,,1644.82,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,967.33,,,1006.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,994.02,,,1778.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1086.8,,,1896.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.6,,,1541.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,337.6,,,1541.28,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1126.32,,,1817.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,866.39,,,1006.97,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1126.32,,,1679.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1106.56,,,1778.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1074.6,,,1877.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,337.6,,,337.6,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,337.6,1074.6,
HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,Px00092110015,CDM,93970,CPT,921,RC,,,,BOTH,,,1127,1014.3,1070.65,,,1014.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,879.06,,,879.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,938.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,574.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,938.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.52,,,574.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,1014.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.92,,,1081.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,828.35,,,879.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,552.23,,,879.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1036.84,,,1036.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,574.77,,,574.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,957.95,,,957.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1070.65,,,1014.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,1070.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,552.23,,,552.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,879.06,1081.92,
PHENTOLAMINE MESYLATE FOR INJ 5 MG,Rx00143956401,CDM,J2760,HCPCS,636,RC,143956401,NDC,,BOTH,5,ME,1130.62,1018.34,1074.09,,,1017.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,881.88,,,882.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.56,,,941.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.56,,,576.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.56,,,941.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,554,,,576.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1017.56,,,1017.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1085.4,,,1085.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,831.01,,,882.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,554,,,882.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1040.17,,,1040.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,554,,,576.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,961.03,,,961.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1074.09,,,1017.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.56,,,1074.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,554,,,554,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,881.88,1085.4,
HC PR 29883 ARTHROSCOPY WITH MENISCUS REPAIR MEDIAL & LATERAL,Px00097513652,CDM,29883,CPT,975,RC,,,,BOTH,,,1998,1798.2,1118.88,,,1798.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1072.78,,,1558.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1248.75,,,1663.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1248.75,,,1018.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1248.75,,,1663.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,985.55,,,1018.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1005.71,,,1798.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1098.9,,,1918.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1558.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1558.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1138.86,,,1838.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,856.73,,,1018.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1138.86,,,1698.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1118.88,,,1798.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1090.8,,,1898.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,1090.8,
HC ED FAC E&M VISIT LEVEL 4 CDM,Px00045010213,CDM,99284,CPT,450,RC,,,,OUTPATIENT,,,1141,811.8,1083.95,,,892.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,889.98,,,773.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1026.9,,,825.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1026.9,,,505.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1026.9,,,825.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.09,,,505.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1026.9,,,892.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1095.36,,,952.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,838.64,,,773.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,564.68,,,773.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1049.72,,,912.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.09,,,505.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,969.85,,,843.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1083.95,,,892.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1026.9,,,942.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,559.09,,,559.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,889.98,1095.36,
HC PR 15100 SKIN SPLT GRFT TRNK/ARM/LEG FIRST 100 SQ CM OR LESS,Px00097510311,CDM,15100,CPT,975,RC,,,,BOTH,,,1658,1492.2,928.48,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,916.88,,,1293.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,1372.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,812.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1036.25,,,1372.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,809.65,,,812.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,849.56,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,911.9,,,973.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,704.04,,,1293.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,704.04,,,1293.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.06,,,1525.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,725.16,,,844.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,945.06,,,1409.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,928.48,,,1492.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1099.8,,,1575.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,704.04,,,704.04,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,704.04,1099.8,
INFLIXIMAB FOR IV INJ 100 MG,Rx57894016001,CDM,J1745,HCPCS,636,RC,57894016001,NDC,,BOTH,100,ME,1153.2,1038.66,1095.54,,,1038.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,899.5,,,899.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1037.88,,,960.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1037.88,,,587.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1037.88,,,960.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.07,,,587.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1037.88,,,1038.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1107.07,,,1107.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,847.6,,,899.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,565.07,,,899.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1060.94,,,1061.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.07,,,587.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,980.22,,,980.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1095.54,,,1038.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1037.88,,,1095.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.07,,,565.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,899.5,1107.07,
HC FOCUS HARMONIC 9CM SHEAR CURVED ETHICON,Sx00000002592,CDM,,,270,RC,,,,BOTH,,,1153.38,1049.06,1095.71,,,1049.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,899.64,,,909.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1038.04,,,970.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1038.04,,,594.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1038.04,,,970.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.16,,,594.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1038.04,,,1049.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1107.24,,,1119,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,847.73,,,909.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,570.81,,,909.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1061.11,,,1072.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.16,,,594.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,980.37,,,990.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1095.71,,,1049.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1038.04,,,1107.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.16,,,565.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,899.64,1107.24,
HC FIBERTAK RC TRIPLOAD TAPE BL/W,Sx0000AR-3633,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1155,1039.5,1097.25,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,900.9,,,900.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,961.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,588.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,961.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,588.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.8,,,1108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,848.93,,,900.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,571.61,,,900.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1062.6,,,1062.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,588.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,981.75,,,981.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.25,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,1097.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,565.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,900.9,1108.8,
HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY CDM,Px00041010292,CDM,94002,CPT,410,RC,,,,BOTH,,,1155,1039.5,1097.25,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,900.9,,,900.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,961.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,588.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,961.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,588.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.8,,,1108.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,848.93,,,900.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,571.61,,,900.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1062.6,,,1062.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,588.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,981.75,,,981.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.25,,,1039.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1039.5,,,1097.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,565.95,,,565.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,900.9,1108.8,
HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE,Px00031010739,CDM,81479,CPT,300,RC,,,,BOTH,,,1156,1040.4,1098.2,,,1040.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,901.68,,,901.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.4,,,962.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.4,,,589.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.4,,,962.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,566.44,,,589.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1040.4,,,1040.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1109.76,,,1109.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,849.66,,,901.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,572.1,,,901.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1063.52,,,1063.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,566.44,,,589.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,982.6,,,982.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1098.2,,,1040.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.4,,,1098.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,566.44,,,566.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,901.68,1109.76,
HC SCREW DART FIRE 4.0MM HEADED,Sx00D1N40030S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1161,1044.9,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,905.58,,,905.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,591.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1114.56,,,1114.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.34,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.58,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1068.12,,,1068.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,986.85,,,986.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1102.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,568.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,905.58,1114.56,
HC LOCKING SCREW T10 FULL THREAD 3.5MM / L22MM,Sx00000657322,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1161,1044.9,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,905.58,,,905.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,591.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1114.56,,,1114.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.34,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.58,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1068.12,,,1068.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,986.85,,,986.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1102.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,568.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,905.58,1114.56,
HC LOCKING SCREW T10 FULL THREAD 3.5MM / L28MM,Sx00000657328,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1161,1044.9,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,905.58,,,905.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,591.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1114.56,,,1114.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.34,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.58,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1068.12,,,1068.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,986.85,,,986.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1102.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,568.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,905.58,1114.56,
HC LOCKING SCREW T10 FULL THREAD 3.5MM / L40MM,Sx00000657304,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1161,1044.9,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,905.58,,,905.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,591.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,966.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1114.56,,,1114.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,853.34,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,574.58,,,905.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1068.12,,,1068.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,591.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,986.85,,,986.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1102.95,,,1044.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1044.9,,,1102.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,568.89,,,568.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,905.58,1114.56,
HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM,Px00041010296,CDM,94003,CPT,410,RC,,,,BOTH,,,1164,1047.6,1105.8,,,1047.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.92,,,907.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.6,,,968.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.6,,,593.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.6,,,968.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570.36,,,593.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1047.6,,,1047.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1117.44,,,1117.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,855.54,,,907.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,576.06,,,907.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1070.88,,,1070.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570.36,,,593.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,989.4,,,989.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1105.8,,,1047.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1047.6,,,1105.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,570.36,,,570.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,907.92,1117.44,
HC SCREW 7.5 X 80MM 16MM THREAD,Sx000130-7050,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1167,1050.3,1108.65,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,910.26,,,910.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,971.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,594.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,971.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,594.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.32,,,1120.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,857.75,,,910.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,577.55,,,910.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1073.64,,,1073.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,594.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,991.95,,,991.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.65,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,1108.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,571.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,910.26,1120.32,
HC SCREW 7.5 X 85MM 16MM THREAD,Sx000130-7085,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1167,1050.3,1108.65,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,910.26,,,910.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,971.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,594.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,971.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,594.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.32,,,1120.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,857.75,,,910.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,577.55,,,910.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1073.64,,,1073.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,594.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,991.95,,,991.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.65,,,1050.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1050.3,,,1108.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,571.83,,,571.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,910.26,1120.32,
"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)",Rx13533031801,CDM,90375,CPT,636,RC,13533031801,NDC,,BOTH,1,ML,1181.95,1497.51,1122.85,,,3191.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.92,,,2765.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1063.76,,,2951.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1063.76,,,1806.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1063.76,,,2951.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,579.16,,,1806.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1063.76,,,3191.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134.67,,,3404.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,868.73,,,2765.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,579.16,,,2765.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1087.39,,,3262.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,579.16,,,1806.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1004.66,,,3013.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1122.85,,,3191.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1063.76,,,3368.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,579.16,,,579.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,921.92,1134.67,
HC MENISCAL CINCH II,Sx0000AR-4501,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1185,1066.5,1125.75,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,924.3,,,924.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,986.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,603.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,986.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,603.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1137.6,,,1137.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,870.98,,,924.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,586.46,,,924.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1090.2,,,1090.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,603.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1007.25,,,1007.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1125.75,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,1125.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,580.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,924.3,1137.6,
HC SP FIBERTAK RC DBLOAD TAPE BL/W BLK/W,Sx00AR-3632SP,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1185,1066.5,1125.75,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,924.3,,,924.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,986.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,603.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,986.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,603.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1137.6,,,1137.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,870.98,,,924.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,586.46,,,924.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1090.2,,,1090.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,603.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1007.25,,,1007.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1125.75,,,1066.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1066.5,,,1125.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,580.65,,,580.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,924.3,1137.6,
TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML,Rx13533063420,CDM,J1670,HCPCS,636,RC,13533063420,NDC,,BOTH,1,ML,1186.82,1068.14,1127.48,,,1127.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,925.72,,,925.72,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1068.14,,,1068.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1068.14,,,1068.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1068.14,,,1068.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,581.54,,,581.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1068.14,,,1068.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1139.35,,,1139.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,872.31,,,872.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,581.54,,,581.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1091.87,,,1091.87,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,581.54,,,581.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1008.8,,,1008.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1127.48,,,1127.48,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1068.14,,,1068.14,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,581.54,,,581.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,925.72,1139.35,
HC PUNCTURE ASPIRATION CYST BREAST CDM,Px00076100036,CDM,19000,CPT,361,RC,,,,BOTH,,,1187,1068.3,1127.65,,,1068.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,925.86,,,925.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1068.3,,,988.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1068.3,,,604.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1068.3,,,988.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.63,,,604.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1068.3,,,1068.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1139.52,,,1139.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,872.45,,,925.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,587.45,,,925.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1092.04,,,1092.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.63,,,604.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1008.95,,,1008.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1127.65,,,1068.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1068.3,,,1127.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,581.63,,,581.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,925.86,1139.52,
HC TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE  CDM,Px00076100032,CDM,12020,CPT,761,RC,,,,BOTH,,,1191,1071.9,1131.45,,,1071.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,928.98,,,928.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1071.9,,,991.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1071.9,,,606.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1071.9,,,991.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.59,,,606.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1071.9,,,1071.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1143.36,,,1143.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,875.39,,,928.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,583.59,,,928.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1095.72,,,1095.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.59,,,606.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1012.35,,,1012.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1131.45,,,1071.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1071.9,,,1131.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,583.59,,,583.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,928.98,1143.36,
HC PIN SET UNIVERS REVERS NOT IMPLANT,Sx000AR-9507S,CDM,,,270,RC,,,,BOTH,,,1200,1080,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,611.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1104,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1020,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1140,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC INIVERSAL APEX SUTURE KIT,Sx0000AR-7298,CDM,,,270,RC,,,,BOTH,,,1200,1080,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,611.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1104,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1020,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1140,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC BC SWIVELOCK 3.9X17.9MM,Sx0AR-2326BCC,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1200,1080,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,611.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1104,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1020,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1140,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC SUTURE ANCHOR BIOCOMP PUSHLOCK SHORT 2.9X12.5MM,Sx00AR-2923BC,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1200,1080,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,936,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,611.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,998.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1152,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,936,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1104,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,611.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1020,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1140,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC SUTURE 2324BCC BIOCOMP ANCHOR 4.75 X 19.1MM,Sx0AR-2324BCC,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1200,1080,1140,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,945.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1008.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,617.635,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1008.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,617.635,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1163.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,945.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,945.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1115.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,617.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1030.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1151.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC SUTURE ANCHOR BIOCOMP CL EYELE 4.75 19.1MM AR-2324BCC,Sx0AR-2324BCC,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1200,1101.6,1140,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,936,,,945.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1008.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,617.635,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1008.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,617.635,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152,,,1163.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,945.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,593.88,,,945.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1104,,,1115.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,617.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1020,,,1030.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1140,,,1090.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080,,,1151.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588,,,588,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,936,1152,
HC ED CASIRIVIMAB IMDEVIMAB INFUSION OR INJECTION ADMIN M0243,Px00045000011,CDM,M0243,CPT,450,RC,,,,OUTPATIENT,,,1202,855,1141.9,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.56,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,869.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,532.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,869.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,532.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1153.92,,,1003.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,883.47,,,815.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.87,,,815.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1105.84,,,961.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,532.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1021.7,,,888.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1141.9,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,992.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,588.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,937.56,1153.92,
HC ED SOTROVIMAB INFUSION ADMIN M0247,Px00045000004,CDM,M0247,CPT,450,RC,,,,OUTPATIENT,,,1202,855,1141.9,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.56,,,815.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,869.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,532.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,869.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,532.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1153.92,,,1003.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,883.47,,,815.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,594.87,,,815.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1105.84,,,961.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,532.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1021.7,,,888.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1141.9,,,940.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.8,,,992.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,588.98,,,588.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,937.56,1153.92,
TELAVANCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT),Rx62847000101,CDM,J3095,HCPCS,636,RC,62847000101,NDC,,BOTH,750,ME,1206.43,1085.79,1146.11,,,1146.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,941.02,,,941.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1085.79,,,1085.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1085.79,,,1085.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1085.79,,,1085.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,591.15,,,591.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1085.79,,,1085.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1158.17,,,1158.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,886.73,,,886.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,591.15,,,591.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1109.92,,,1109.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,591.15,,,591.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1025.47,,,1025.47,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1146.11,,,1146.11,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1085.79,,,1085.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,591.15,,,591.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,941.02,1158.17,
HC REUNITE ORTHO PIN SYS 1.5X40MM W/DISPOSABLE INSTRUMENTS,Sx00000948230,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1218,1096.2,1157.1,,,1096.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,950.04,,,950.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1096.2,,,1013.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1096.2,,,620.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1096.2,,,1013.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,596.82,,,620.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1096.2,,,1096.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1169.28,,,1169.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.23,,,950.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,602.79,,,950.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1120.56,,,1120.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,596.82,,,620.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1035.3,,,1035.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.1,,,1096.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1096.2,,,1157.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,596.82,,,596.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,950.04,1169.28,
HC SCREW CANNULATED COMPR 4X26MM FIXOS,Sx000000MV26A,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1219.2,1097.28,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,950.98,,,950.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,621.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170.43,,,1170.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.11,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1121.66,,,1121.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1036.32,,,1036.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1158.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,597.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,950.98,1170.43,
HC SCREW CANNULATED COMPR 4X36MM FIXOS,Sx000000MV36A,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1219.2,1097.28,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,950.98,,,950.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,621.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170.43,,,1170.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.11,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1121.66,,,1121.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1036.32,,,1036.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1158.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,597.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,950.98,1170.43,
HC SCREW CANNULATED COMPR 4X42MM FIXOS,Sx000000MV42A,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1219.2,1097.28,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,950.98,,,950.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,621.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1014.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170.43,,,1170.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.11,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,603.38,,,950.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1121.66,,,1121.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,621.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1036.32,,,1036.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.24,,,1097.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.28,,,1158.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,597.41,,,597.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,950.98,1170.43,
HC DEB MUSC/FASCIA 20SQ CM/<,Px00076110057,CDM,11043,CPT,761,RC,,,,BOTH,,,1228,1105.2,1166.6,,,1105.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,957.84,,,957.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1105.2,,,924.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1105.2,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1105.2,,,924.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1105.2,,,1105.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1178.88,,,213.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,902.58,,,957.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,957.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1129.76,,,1129.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,625.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1043.8,,,1043.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1166.6,,,1105.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1105.2,,,1166.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,601.72,,,601.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,957.84,1178.88,
HC PR 29828 ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS,Px00097510648,CDM,29828,CPT,975,RC,,,,BOTH,,,2170,1953,1215.2,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1171.1,,,1692.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1806.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1356.25,,,1806.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1040.62,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1084.58,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1193.5,,,2083.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1692.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1692.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1236.9,,,1996.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,932.04,,,1105.83,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1236.9,,,1844.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1215.2,,,1953,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1180.79,,,2061.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,1180.79,
HC VENTRALEX HERNIA PATCH SMALL 1.7 INCH WITH STRAP,Sx00000010301,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1231.2,1108.08,1169.64,,,1108.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,960.34,,,960.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.08,,,1024.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.08,,,627.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.08,,,1024.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,603.29,,,627.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1108.08,,,1108.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1181.95,,,1181.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,904.93,,,960.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,609.32,,,960.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1132.7,,,1132.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,603.29,,,627.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1046.52,,,1046.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1169.64,,,1108.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1108.08,,,1169.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,603.29,,,603.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,960.34,1181.95,
HC T2 F/T LOCKING SCREW 5mmX40mm,Sx01896-5040S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1233,1109.7,1171.35,,,1109.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,961.74,,,961.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1109.7,,,1026.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1109.7,,,628.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1109.7,,,1026.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,628.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1109.7,,,1109.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1183.68,,,1183.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,906.26,,,961.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,610.21,,,961.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134.36,,,1134.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,628.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1048.05,,,1048.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1171.35,,,1109.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1109.7,,,1171.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,604.17,,,604.17,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,961.74,1183.68,
HC PACU ACUITY 1,Px00071010227,CDM,,,710,RC,,,,BOTH,,,1235,1111.5,1173.25,,,1111.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,963.3,,,963.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1111.5,,,1028.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1111.5,,,629.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1111.5,,,1028.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,605.15,,,629.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1111.5,,,1111.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1185.6,,,1185.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.73,,,963.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,605.15,,,963.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1136.2,,,1136.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,605.15,,,629.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1049.75,,,1049.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1173.25,,,1111.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1111.5,,,1173.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,605.15,,,605.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,963.3,1185.6,
HC PR 59514 CESAREAN DELIVERY ONLY,Px00097511320,CDM,59514,CPT,975,RC,,,,BOTH,,,2179,1961.1,1220.24,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.04,,,1699.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1813.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1813.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,990.98,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1083.04,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1198.45,,,2091.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,1699.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,1699.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1242.03,,,2004.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,887.57,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1242.03,,,1852.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1220.24,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1194.3,,,2070.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,170.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,170.28,1194.3,
HC PR 59514 CESAREAN DELIVERY ONLY ASST,Px00098310448,CDM,59514,CPT,983,RC,,,,BOTH,,,2179,1961.1,1220.24,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,981.04,,,1699.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1813.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1361.88,,,1813.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,990.98,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1083.04,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1198.45,,,2091.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,1699.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,1699.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1242.03,,,2004.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,887.57,,,1110.42,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1242.03,,,1852.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1220.24,,,1961.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1194.3,,,2070.05,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,170.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,170.28,1194.3,
HC FLIPCUTTER III DRILL,Sx00AR-1204FF,CDM,,,270,RC,,,,BOTH,,,1245,1120.5,1182.75,,,1120.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,971.1,,,971.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.5,,,1036.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.5,,,634.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.5,,,1036.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.05,,,634.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1120.5,,,1120.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1195.2,,,1195.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,915.08,,,971.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,616.15,,,971.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1145.4,,,1145.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.05,,,634.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1058.25,,,1058.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.75,,,1120.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.5,,,1182.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,610.05,,,610.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,971.1,1195.2,
HC LIGASURE BLUNT TIP,Sx00000LF1837,CDM,,,270,RC,,,,BOTH,,,1246.95,1122.26,1184.6,,,1122.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,972.62,,,972.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1122.26,,,1037.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1122.26,,,635.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1122.26,,,1037.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.01,,,635.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1122.26,,,1122.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1197.07,,,1197.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,916.51,,,972.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,617.12,,,972.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1147.19,,,1147.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.01,,,635.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1059.91,,,1059.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1184.6,,,1122.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1122.26,,,1184.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,611.01,,,611.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,972.62,1197.07,
HC PR 44180 LAPAROSCOPY ENTEROLYSIS,Px00097510599,CDM,44180,CPT,975,RC,,,,BOTH,,,2186,1967.4,1224.16,,,1967.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1245,,,1705.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1366.25,,,1819.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1366.25,,,1113.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1366.25,,,1819.63,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1024.03,,,1113.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1095.87,,,1967.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1202.3,,,2098.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.82,,,1705.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,84.82,,,1705.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1246.02,,,2011.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,917.17,,,1113.99,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1246.02,,,1858.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1224.16,,,1967.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,2076.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,84.82,,,84.82,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,84.82,1198.8,
HC REUNITE ORTHO PIN SYS 2X40MM W/DISPOSABLE INSTRUMENTS,Sx00000948231,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1254,1128.6,1191.3,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,978.12,,,978.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1043.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,639.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1043.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,639.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1203.84,,,1203.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.69,,,978.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,620.6,,,978.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1153.68,,,1153.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,639.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1065.9,,,1065.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1191.3,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1191.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,614.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,978.12,1203.84,
HC CROSS CHECK LAG SCREW 3.5X24,Sx005820X3524,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1254,1128.6,1191.3,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,978.12,,,978.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1043.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,639.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1043.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,639.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1203.84,,,1203.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,921.69,,,978.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,620.6,,,978.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1153.68,,,1153.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,639.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1065.9,,,1065.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1191.3,,,1128.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1128.6,,,1191.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,614.46,,,614.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,978.12,1203.84,
HC MESH PROCEED HERNIA 4X6,Sx000000PCDN1,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1256.04,1165.24,1193.24,,,1165.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,979.71,,,1009.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1130.44,,,1077.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1130.44,,,659.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1130.44,,,1077.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.46,,,659.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1130.44,,,1165.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1205.8,,,1242.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,923.19,,,1009.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,621.61,,,1009.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1155.56,,,1191.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.46,,,659.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1067.63,,,1100.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1193.24,,,1165.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1130.44,,,1229.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,615.46,,,615.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,979.71,1205.8,
HC PIN SET MODULAR GLENOID SYSTEM,Sx000AR-9607S,CDM,,,270,RC,,,,BOTH,,,1260,1134,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,982.8,,,982.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,642.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1209.6,,,1209.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.1,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.57,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.2,,,1159.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1071,,,1071,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1197,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,617.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,982.8,1209.6,
HC DYNANITE VIP GLENOID PIN NITINOL 2.8MM,SxAR-5400-400,CDM,,,270,RC,,,,BOTH,,,1260,1134,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,982.8,,,982.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,642.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1209.6,,,1209.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.1,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.57,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.2,,,1159.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1071,,,1071,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1197,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,617.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,982.8,1209.6,
HC FIBERTAK,Sx00PTC012831,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1260,1134,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,982.8,,,982.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,642.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1209.6,,,1209.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.1,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.57,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.2,,,1159.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1071,,,1071,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1197,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,617.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,982.8,1209.6,
HC FIBERTAK KNOTLESS ANCHOR,Sx0000AR-3638,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1260,1134,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,982.8,,,982.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,642.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1048.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1209.6,,,1209.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,926.1,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,623.57,,,982.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.2,,,1159.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,642.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1071,,,1071,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1197,,,1134,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1134,,,1197,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,617.4,,,617.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,982.8,1209.6,
HC REMOVAL TUNNELED CV CATH W/PORT OR PUMP,Px00036110449,CDM,36590,CPT,361,RC,,,,BOTH,,,1270,1143,1206.5,,,1143,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,990.6,,,990.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1143,,,953.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1143,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1143,,,953.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.3,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1143,,,1143,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.2,,,282.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,933.45,,,990.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,628.52,,,990.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1168.4,,,1168.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.3,,,647.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1079.5,,,1079.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1206.5,,,1143,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1143,,,1206.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,622.3,,,622.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,990.6,1219.2,
HC DX SWIVELOCK SL 3.5X8.5MM WITH FORK EYELET,Sx000AR-8978P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1275,1147.5,1211.25,,,1147.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,994.5,,,994.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1147.5,,,1061.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1147.5,,,649.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1147.5,,,1061.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.75,,,649.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1147.5,,,1147.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1224,,,1224,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.13,,,994.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,631,,,994.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1173,,,1173,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.75,,,649.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1083.75,,,1083.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1211.25,,,1147.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1147.5,,,1211.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,624.75,,,624.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,994.5,1224,
HC GUIDE WIRE BALL TIP 3.0X1000mm STERILE,Sx01806-0085S,CDM,,,270,RC,,,,BOTH,,,1278,1150.2,1214.1,,,1150.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,996.84,,,996.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1150.2,,,1063.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1150.2,,,651.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1150.2,,,1063.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.22,,,651.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1150.2,,,1150.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1226.88,,,1226.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,939.33,,,996.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,632.48,,,996.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1175.76,,,1175.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.22,,,651.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1086.3,,,1086.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1214.1,,,1150.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1150.2,,,1214.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,626.22,,,626.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,996.84,1226.88,
HC CT UPPER EXTREMITY W CONTRAST,Px00035210031,CDM,73201,CPT,350,RC,,,,BOTH,,,1281,1152.9,1216.95,,,1152.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,999.18,,,999.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152.9,,,1066.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152.9,,,652.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152.9,,,1066.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.69,,,652.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1152.9,,,1152.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1229.76,,,1229.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,941.54,,,999.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,633.97,,,999.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1178.52,,,1178.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.69,,,652.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1088.85,,,1088.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1216.95,,,1152.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1152.9,,,1216.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,627.69,,,627.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,999.18,1229.76,
FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML),Rx55513020991,CDM,J1442,HCPCS,636,RC,55513020991,NDC,,BOTH,0.8,ML,1289.54,1161.47,1225.06,,,1160.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1005.84,,,1006.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1160.59,,,1073.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1160.59,,,657.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1160.59,,,1073.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.87,,,657.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1160.59,,,1160.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1237.96,,,1238.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,947.81,,,1006.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,631.87,,,1006.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1186.38,,,1186.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.87,,,657.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1096.11,,,1096.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.06,,,1160.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1160.59,,,1225.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,631.87,,,631.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1005.84,1237.96,
HC CT NECK SPINE W/DYE,Px00035210009,CDM,72126,CPT,350,RC,,,,BOTH,,,1300,1170,1235,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014,,,1014,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1082.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,662.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1082.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,662.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1248,,,1248,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.5,,,1014,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.37,,,1014,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1196,,,1196,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,662.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1105,,,1105,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1235,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1235,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,637,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1014,1248,
HC CT LUMBAR SPINE W CONTRAST,Px00035210015,CDM,72132,CPT,350,RC,,,,BOTH,,,1300,1170,1235,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014,,,1014,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1082.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,662.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1082.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,662.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1248,,,1248,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.5,,,1014,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,643.37,,,1014,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1196,,,1196,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,662.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1105,,,1105,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1235,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1235,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,637,,,637,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1014,1248,
HC CT ABDOMEN W CONTRAST,Px00035210046,CDM,74160,CPT,350,RC,,,,BOTH,,,1303,1172.7,1237.85,,,1172.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1016.34,,,1016.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1172.7,,,1084.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1172.7,,,664.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1172.7,,,1084.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.47,,,664.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1172.7,,,1172.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1250.88,,,1250.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,957.71,,,1016.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,644.85,,,1016.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1198.76,,,1198.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.47,,,664.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1107.55,,,1107.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1237.85,,,1172.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1172.7,,,1237.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,638.47,,,638.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1016.34,1250.88,
HC JAW LAP LIGASURE MARYLAND 37CM,Sx00000LF1937,CDM,,,270,RC,,,,BOTH,,,1305,1174.5,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.9,,,1017.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,665.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1252.8,,,1252.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.18,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1200.6,,,1200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1109.25,,,1109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1239.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,639.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1017.9,1252.8,
HC PROXIMAL TENODESIS BUTTON REV,Sx0000AR-2291,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1305,1174.5,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.9,,,1017.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,665.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1252.8,,,1252.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.18,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1200.6,,,1200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1109.25,,,1109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1239.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,639.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1017.9,1252.8,
HC CT PELVIS W CONTRAST,Px00035210020,CDM,72193,CPT,350,RC,,,,BOTH,,,1305,1174.5,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.9,,,1017.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,665.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1252.8,,,1252.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.18,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1200.6,,,1200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1109.25,,,1109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1239.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,639.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1017.9,1252.8,
HC CT LOWER EXTREMITY W CONTRAST,Px00035210040,CDM,73701,CPT,350,RC,,,,BOTH,,,1305,1174.5,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.9,,,1017.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,665.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1086.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1252.8,,,1252.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,959.18,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,645.84,,,1017.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1200.6,,,1200.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,665.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1109.25,,,1109.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1239.75,,,1174.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1174.5,,,1239.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,639.45,,,639.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1017.9,1252.8,
HC CT ORBIT/EAR/FOSSA WO CONTRAST,Px00035110014,CDM,70480,CPT,350,RC,,,,BOTH,,,1317,1185.3,1251.15,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1027.26,,,1027.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1185.3,,,1096.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1185.3,,,671.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1185.3,,,1096.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.33,,,671.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1185.3,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1264.32,,,1264.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968,,,1027.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,651.78,,,1027.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1211.64,,,1211.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.33,,,671.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1119.45,,,1119.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1251.15,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1185.3,,,1251.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,645.33,,,645.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1027.26,1264.32,
HC PR 58353 ENDOMETRIAL ABLATION THERMAL,Px00097511096,CDM,58353,CPT,975,RC,,,,BOTH,,,2540,2286,1422.4,,,2286,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.4,,,1981.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1587.5,,,2114.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1587.5,,,1294.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1587.5,,,2114.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,259.16,,,1294.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,255.54,,,2286,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1397,,,2438.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.36,,,1981.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.36,,,1981.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1447.8,,,2336.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,232.12,,,1294.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1447.8,,,2159,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1422.4,,,2286,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1275.75,,,2413,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.36,,,225.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,225.36,1275.75,
HC T2 F/T LOCKING SCREW 5mmX37.5mm,Sx01896-5037S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1332,1198.8,1265.4,,,1198.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1038.96,,,1038.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,1108.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,678.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,1108.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,652.68,,,678.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,1198.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1278.72,,,1278.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,979.02,,,1038.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,659.21,,,1038.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1225.44,,,1225.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,652.68,,,678.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1132.2,,,1132.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1265.4,,,1198.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.8,,,1265.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,652.68,,,652.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1038.96,1278.72,
"HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR",Px00097510677,CDM,29888,CPT,975,RC,,,,BOTH,,,2312,2080.8,1294.72,,,2080.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1245.82,,,1803.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1445,,,1907.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1445,,,1109.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1445,,,1907.38,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1103.49,,,1109.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1173.23,,,2080.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1271.6,,,1343.78,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1803.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,1803.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1317.84,,,2127.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,988.35,,,1178.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1317.84,,,1965.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1294.72,,,2080.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1278.9,,,2196.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,415.97,,,415.97,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,415.97,1278.9,
HC PACU ACUITY 2,Px00071010228,CDM,,,710,RC,,,,BOTH,,,1359,1223.1,1291.05,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1060.02,,,1060.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.64,,,1304.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,998.87,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1250.28,,,1250.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1155.15,,,1155.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1291.05,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1291.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,665.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1060.02,1304.64,
HC TOPAZ MICRODEBRIDER IFS 0.8MM,Sx0ACH4040-01,CDM,,,270,RC,,,,BOTH,,,1359,1223.1,1291.05,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1060.02,,,1060.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.64,,,1304.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,998.87,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,672.57,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1250.28,,,1250.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1155.15,,,1155.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1291.05,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.1,,,1291.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,665.91,,,665.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1060.02,1304.64,
HC ACE HARMONIC SCALPEL HAR36 PISTOL GRIP W/ERG HANDLE,Sx000000HAR36,CDM,,,270,RC,,,,BOTH,,,1361.33,1132.02,1293.26,,,1132.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1061.84,,,981.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.2,,,1047,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.2,,,640.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.2,,,1047,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.05,,,640.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1225.2,,,1132.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1306.88,,,1207.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1000.58,,,981.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,673.72,,,981.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1252.42,,,1157.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.05,,,640.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1157.13,,,1069.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1293.26,,,1132.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.2,,,1194.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,667.05,,,667.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1061.84,1306.88,
HC STAPLER LINEAR CONTOUR CURVED 40MM STANDARD,Sx000000CS40B,CDM,,,270,RC,,,,BOTH,,,1365.06,1228.55,1296.81,,,1228.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1064.75,,,1064.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.55,,,1136.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.55,,,695.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.55,,,1136.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,668.88,,,695.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1228.55,,,1228.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1310.46,,,1310.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1003.32,,,1064.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,675.57,,,1064.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1255.86,,,1255.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,668.88,,,695.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1160.3,,,1160.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1296.81,,,1228.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.55,,,1296.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,668.88,,,668.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1064.75,1310.46,
HC ACCUPORT CANNULA 11GA X 120MM,Sx0000307.034,CDM,,,270,RC,,,,BOTH,,,1380,1242,1311,,,1242,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1076.4,,,1076.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1242,,,1148.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1242,,,703.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1242,,,1148.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.2,,,703.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1242,,,1242,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1324.8,,,1324.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1014.3,,,1076.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,682.96,,,1076.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1269.6,,,1269.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.2,,,703.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1173,,,1173,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311,,,1242,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1242,,,1311,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,676.2,,,676.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1076.4,1324.8,
TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML,Rx13533063402,CDM,J1670,HCPCS,636,RC,13533063402,NDC,,BOTH,1,ML,1384.73,1209.95,1315.49,,,1246.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080.09,,,1080.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1246.26,,,1152.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1246.26,,,705.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1246.26,,,1152.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,678.52,,,705.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1246.26,,,1246.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1329.34,,,1329.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1017.78,,,1080.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,678.52,,,1080.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1273.95,,,1273.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,678.52,,,705.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1177.02,,,1177.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1315.49,,,1246.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1246.26,,,1315.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,678.52,,,678.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1080.09,1329.34,
HC FIBERTAK SELF BUNCHING KL 1.8 SHOULDER,Sx0000AR-3636,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1386,1247.4,1316.7,,,1247.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1081.08,,,1081.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1247.4,,,1153.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1247.4,,,706.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1247.4,,,1153.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,706.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1247.4,,,1247.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1330.56,,,1330.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1018.71,,,1081.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,685.93,,,1081.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1275.12,,,1275.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,706.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1178.1,,,1178.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1316.7,,,1247.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1247.4,,,1316.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,679.14,,,679.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1081.08,1330.56,
HC CT ANGIO LWR EXTR W/O&W/DYE,Px00035010020,CDM,73706,CPT,350,RC,,,,BOTH,,,1400,1260,1330,,,1260,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1092,,,1092,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1260,,,1165.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1260,,,713.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1260,,,1165.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,686,,,713.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1260,,,1260,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1344,,,1344,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1029,,,1092,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,692.86,,,1092,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1288,,,1288,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,686,,,713.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1190,,,1190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1330,,,1260,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1260,,,1330,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,686,,,686,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1092,1344,
HC OXFORD SAWBLADE STABLECUT,Sx00000506298,CDM,,,270,RC,,,,BOTH,,,1404.54,1264.09,1334.31,,,1264.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1095.54,,,1095.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1264.09,,,1169.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1264.09,,,715.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1264.09,,,1169.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,688.22,,,715.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1264.09,,,1264.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1348.36,,,1348.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1032.34,,,1095.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,695.11,,,1095.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1292.18,,,1292.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,688.22,,,715.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1193.86,,,1193.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1334.31,,,1264.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1264.09,,,1334.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,688.22,,,688.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1095.54,1348.36,
HC CANNULATED DRILL 2.7MM AO FIT,Sx00000705250,CDM,,,270,RC,,,,BOTH,,,1407,1266.3,1336.65,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.46,,,1097.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1171.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,717.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1171.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,717.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350.72,,,1350.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1034.15,,,1097.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,696.32,,,1097.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1294.44,,,1294.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,717.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1195.95,,,1195.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.65,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1336.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,689.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1097.46,1350.72,
HC CANNULATED DRILL 4.9MM LG AO,Sx00000705252,CDM,,,270,RC,,,,BOTH,,,1407,1266.3,1336.65,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1097.46,,,1097.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1171.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,717.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1171.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,717.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350.72,,,1350.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1034.15,,,1097.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,696.32,,,1097.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1294.44,,,1294.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,717.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1195.95,,,1195.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.65,,,1266.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1266.3,,,1336.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,689.43,,,689.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1097.46,1350.72,
HC PR 59410 VAGINAL DELIVERY ONLY W/POSTPARTUM CARE,Px00097511313,CDM,59410,CPT,975,RC,,,,BOTH,,,2546,2291.4,1425.76,,,2291.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1153.17,,,1985.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1591.25,,,2119.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1591.25,,,1297.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1591.25,,,2119.29,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1188.76,,,1297.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1229.68,,,2291.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1400.3,,,2444.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,1985.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,1985.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1451.22,,,2342.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1064.71,,,1297.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1451.22,,,2164.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1425.76,,,2291.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1351.8,,,2418.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,141.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.27,1351.8,
"HC PR 25609 OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG [25609] CDM",Px00097500046,CDM,25609,CPT,975,RC,,,,BOTH,,,2417,2175.3,1353.52,,,2175.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1348.18,,,1885.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1510.63,,,2011.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1510.63,,,1231.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1510.63,,,2011.91,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1206.81,,,1231.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1247.55,,,2175.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1329.35,,,2320.32,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,1885.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,1885.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1377.69,,,2223.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1080.88,,,1231.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1377.69,,,2054.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1353.52,,,2175.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1352.25,,,2296.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,519.48,,,519.48,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,519.48,1352.25,
HC SUTURE 2324BCCT BIOCOMP FIBO 4.75 X 19.1MM ANCHOR,SxAR-2324BCCT,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1410,1269,1339.5,,,1269,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1099.8,,,1099.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269,,,1173.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269,,,718.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269,,,1173.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.9,,,718.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1269,,,1269,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1353.6,,,1353.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1036.35,,,1099.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,697.81,,,1099.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1297.2,,,1297.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.9,,,718.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1198.5,,,1198.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1339.5,,,1269,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269,,,1339.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,690.9,,,690.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1099.8,1353.6,
"HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",Px00097510676,CDM,29827,CPT,975,RC,,,,BOTH,,,2531,2277.9,1417.36,,,2277.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1362.31,,,1974.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1581.88,,,2088.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1581.88,,,1216.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1581.88,,,2088.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1210.19,,,1216.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1257.25,,,2277.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1392.05,,,1460.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1974.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1974.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1442.67,,,2328.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1084,,,1289.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1442.67,,,2151.35,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1417.36,,,2277.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1368.45,,,2404.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,1368.45,
HC PR 43249 ESOPH EGD DILATION <30 MM,Px00097510503,CDM,43249,CPT,975,RC,,,,BOTH,,,357,321.3,199.92,,,321.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,208.74,,,278.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.13,,,294.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.13,,,171.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,223.13,,,294.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,169.75,,,171.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,186.19,,,321.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,196.35,,,224.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.61,,,278.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.61,,,278.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.49,,,328.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,152.04,,,181.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,203.49,,,303.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,199.92,,,321.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1370.7,,,339.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.61,,,147.61,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,147.61,1370.7,
HC DRILL BIT 3.2X230MM,Sx00000705232,CDM,,,270,RC,,,,BOTH,,,1431,1287.9,1359.45,,,1287.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1116.18,,,1116.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287.9,,,1191.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287.9,,,729.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287.9,,,1191.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.19,,,729.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1287.9,,,1287.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1373.76,,,1373.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1051.79,,,1116.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,708.2,,,1116.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1316.52,,,1316.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.19,,,729.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1216.35,,,1216.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1359.45,,,1287.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287.9,,,1359.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,701.19,,,701.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1116.18,1373.76,
HC PR 29806 SHOULDER ARTHROSCOPY/SURGERY,Px00097512354,CDM,29806,CPT,975,RC,,,,BOTH,,,2505,2254.5,1402.8,,,2254.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1350.05,,,1953.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1565.63,,,2068.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1565.63,,,1208.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1565.63,,,2068.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1201.53,,,1208.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1264.5,,,2254.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1377.75,,,1440.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1953.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,1953.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1427.85,,,2304.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1076.15,,,1276.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1427.85,,,2129.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1402.8,,,2254.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1376.54,,,2379.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,74.78,,,74.78,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,74.78,1376.54,
HC DRILL BIT LOCKING 4.2 X 360MM,Sx02351-4236S,CDM,,,270,RC,,,,BOTH,,,1434,1290.6,1362.3,,,1290.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1118.52,,,1118.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1290.6,,,1193.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1290.6,,,730.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1290.6,,,1193.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.66,,,730.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1290.6,,,1290.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1376.64,,,1376.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1053.99,,,1118.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,709.69,,,1118.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1319.28,,,1319.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.66,,,730.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1218.9,,,1218.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1362.3,,,1290.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1290.6,,,1362.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,702.66,,,702.66,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1118.52,1376.64,
HC 4.75MM BC KNOTLESS SWIVELOCK,SxAR-2324KBCC,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1449,1304.1,1376.55,,,1304.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1130.22,,,1130.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.1,,,1206.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.1,,,738.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.1,,,1206.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.01,,,738.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1304.1,,,1304.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1391.04,,,1391.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1065.02,,,1130.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,717.11,,,1130.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1333.08,,,1333.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.01,,,738.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1231.65,,,1231.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1376.55,,,1304.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1304.1,,,1376.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,710.01,,,710.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1130.22,1391.04,
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION CDM,Px00076100034,CDM,10005,CPT,361,RC,,,,BOTH,,,1457,1311.3,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1136.46,,,1136.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1085.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1085.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.72,,,1398.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1070.9,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,721.07,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1340.44,,,1340.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,742.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1238.45,,,1238.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1384.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,713.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1136.46,1398.72,
HC PERQ DEV LOC BREAST 1ST US IMAG,Px00036111193,CDM,19285,CPT,361,RC,,,,BOTH,,,1457,1311.3,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1136.46,,,1136.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1212.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,742.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1212.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,742.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.72,,,1398.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1070.9,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,721.07,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1340.44,,,1340.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,742.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1238.45,,,1238.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1384.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,713.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1136.46,1398.72,
HC BIOPSY OF THYROID,Px00036010349,CDM,60100,CPT,361,RC,,,,BOTH,,,1457,1311.3,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1136.46,,,1136.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1212.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,742.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1212.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,742.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.72,,,1398.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1070.9,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,721.07,,,1136.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1340.44,,,1340.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,742.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1238.45,,,1238.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.15,,,1311.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.3,,,1384.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,713.93,,,713.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1136.46,1398.72,
HC UNIVERS REVERS SPACER 36+6MM,Sx0AR-9555-06,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1470,1323,1396.5,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1146.6,,,1146.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1223.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,749.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1223.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,749.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1411.2,,,1411.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080.45,,,1146.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,727.5,,,1146.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,749.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1249.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1396.5,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1396.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,720.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1146.6,1411.2,
HC UNIVERS REVERS SPACER 36+12MM,Sx0AR-9555-12,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1470,1323,1396.5,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1146.6,,,1146.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1223.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,749.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1223.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,749.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1411.2,,,1411.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1080.45,,,1146.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,727.5,,,1146.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,749.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1249.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1396.5,,,1323,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1396.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,720.3,,,720.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1146.6,1411.2,
HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,Px00092110010,CDM,93925,CPT,921,RC,,,,BOTH,,,1476,1328.4,1402.2,,,1328.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1151.28,,,1151.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1328.4,,,1228.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1328.4,,,752.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1328.4,,,1228.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,760.29,,,752.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1328.4,,,1328.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1416.96,,,1416.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1084.86,,,1151.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,723.24,,,1151.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1357.92,,,1357.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,752.76,,,752.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1254.6,,,1254.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1402.2,,,1328.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1328.4,,,1402.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,723.24,,,723.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1151.28,1416.96,
HC SP FIBERTAK RC FBRTPE BLK/BLU &STTPE BLU,SxAR-3652TTSP,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1480.5,1332.45,1406.48,,,1332.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1154.79,,,1154.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.45,,,1232.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.45,,,754.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.45,,,1232.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,754.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1332.45,,,1332.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1421.28,,,1421.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1088.17,,,1154.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,732.7,,,1154.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1362.06,,,1362.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,754.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1258.43,,,1258.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.48,,,1332.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.45,,,1406.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.45,,,725.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1154.79,1421.28,
HC SP FIBERTAK RC FBRTPE BLU &STTPE WH/BLK,Sx0AR-3652TSP,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1480.58,1332.45,1406.55,,,1332.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1154.85,,,1154.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.52,,,1232.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.52,,,754.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.52,,,1232.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.48,,,754.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1332.52,,,1332.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1421.36,,,1421.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1088.23,,,1154.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,732.74,,,1154.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1362.13,,,1362.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.48,,,754.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1258.49,,,1258.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.55,,,1332.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.52,,,1406.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,725.48,,,725.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1154.85,1421.36,
HC FIBERSTITCH CURVED 2-0 W/TWO POLYESTER IMPLANTS,Sx0000AR-4570,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1485,1336.5,1410.75,,,1336.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.3,,,1158.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.5,,,1236.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.5,,,756.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.5,,,1236.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.65,,,756.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.5,,,1336.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1425.6,,,1425.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1091.48,,,1158.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,734.93,,,1158.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1366.2,,,1366.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.65,,,756.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1262.25,,,1262.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1410.75,,,1336.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.5,,,1410.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,727.65,,,727.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1158.3,1425.6,
HC PACU ACUITY 3,Px00071010229,CDM,,,710,RC,,,,BOTH,,,1495,1345.5,1420.25,,,1345.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1166.1,,,1166.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,1244.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,761.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,1244.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.55,,,761.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,1345.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.2,,,1435.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1098.83,,,1166.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,732.55,,,1166.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1375.4,,,1375.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.55,,,761.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1270.75,,,1270.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1420.25,,,1345.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,1420.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,732.55,,,732.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1166.1,1435.2,
HC REAMER CANNULATED ENTRY 16.5MM,Sx0000257-000,CDM,,,270,RC,,,,BOTH,,,1496.25,1346.63,1421.44,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.08,,,1167.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1245.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,762.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1245.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,762.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1436.4,,,1436.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1099.74,,,1167.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.49,,,1167.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1376.55,,,1376.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,762.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1271.81,,,1271.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1421.44,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1421.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,733.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1167.08,1436.4,
HC COMPRESSION FT SCREW 5.0 LG 46MM LENGTH,SxAR-8750-46H,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1496.25,1346.63,1421.44,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.08,,,1167.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1245.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,762.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1245.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,762.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1436.4,,,1436.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1099.74,,,1167.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.49,,,1167.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1376.55,,,1376.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,762.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1271.81,,,1271.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1421.44,,,1346.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1346.63,,,1421.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.16,,,733.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1167.08,1436.4,
HC DISPOSABLE KIT T3 AMZ,Sx000AR-13217,CDM,,,270,RC,,,,BOTH,,,1497,1347.3,1422.15,,,1347.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.66,,,1167.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.3,,,1246.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.3,,,762.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.3,,,1246.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.53,,,762.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1347.3,,,1347.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1437.12,,,1437.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1100.3,,,1167.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,740.87,,,1167.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1377.24,,,1377.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.53,,,762.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1272.45,,,1272.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.15,,,1347.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.3,,,1422.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.53,,,733.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1167.66,1437.12,
HC PLATE VARIAX STRAIGHT 5 HOLE IMPLANT,Sx00040-20805,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1497.6,1347.84,1422.72,,,1347.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.13,,,1168.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.84,,,1246.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.84,,,763.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.84,,,1246.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.82,,,763.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1347.84,,,1347.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1437.7,,,1437.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1100.74,,,1168.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,741.16,,,1168.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1377.79,,,1377.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.82,,,763.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1272.96,,,1272.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.72,,,1347.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1347.84,,,1422.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,733.82,,,733.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1168.13,1437.7,
HC CT ABDOMEN WO & W CONTRAST,Px00035210047,CDM,74170,CPT,350,RC,,,,BOTH,,,1499,1349.1,1424.05,,,1349.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1169.22,,,1169.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1349.1,,,1247.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1349.1,,,763.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1349.1,,,1247.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,734.51,,,763.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1349.1,,,1349.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.04,,,1439.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1101.77,,,1169.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,741.86,,,1169.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1379.08,,,1379.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,734.51,,,763.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1274.15,,,1274.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1424.05,,,1349.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1349.1,,,1424.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,734.51,,,734.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1169.22,1439.04,
HC PLATE TIBIAL 35MM SBI EXPLANT,Sx400-262 *EX,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1500,1350,1425,,,1350,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1170,,,1170,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350,,,1248.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350,,,764.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350,,,1248.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,735,,,764.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1350,,,1350,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1440,,,1440,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1102.5,,,1170,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,1170,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1380,,,1380,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,735,,,764.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1275,,,1275,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1425,,,1350,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1350,,,1425,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,735,,,735,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1170,1440,
"HC PR 43220 ESOPHAGUS ENDOSCOPY DILATION, BALLOON <30MM",Px00097510291,CDM,43220,CPT,975,RC,,,,BOTH,,,948,853.2,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,160.63,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,592.5,,,789.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,131.64,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,142.67,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,521.4,,,910.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.47,,,739.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,114.47,,,739.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,872.16,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,117.9,,,483.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,540.36,,,805.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,530.88,,,853.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1446.75,,,900.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,114.47,,,114.47,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,114.47,1446.75,
HC PREVENA PEEL AND PLACE 20CM KIT,Sx00PRE1001US,CDM,,,270,RC,,,,BOTH,,,1514.7,1363.23,1438.97,,,1363.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1181.47,,,1181.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.23,,,1260.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.23,,,771.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.23,,,1260.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.2,,,771.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1363.23,,,1363.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1454.11,,,1454.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1113.3,,,1181.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,749.63,,,1181.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1393.52,,,1393.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.2,,,771.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1287.5,,,1287.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1438.97,,,1363.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.23,,,1438.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.2,,,742.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1181.47,1454.11,
HC ED REPAIR OF NAIL BED CDM,Px00045010353,CDM,11760,CPT,450,RC,,,,OUTPATIENT,,,1515,1077.3,1439.25,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1181.7,,,1027.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.5,,,1096.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.5,,,671.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.5,,,1096.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,671.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1363.5,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1454.4,,,1264.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1113.53,,,1027.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,749.77,,,1027.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1393.8,,,1211.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,671.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1287.75,,,1119.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.25,,,1185.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1363.5,,,1251.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,742.35,,,742.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1181.7,1454.4,
HC PR 49606 RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH CDM,Px00097513037,CDM,49606,CPT,975,RC,,,,BOTH,,,2716,2444.4,1520.96,,,2444.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1533.61,,,2118.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1697.5,,,2260.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1697.5,,,1384.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1697.5,,,2260.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1261.64,,,1384.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1348.63,,,2444.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1493.8,,,2607.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,2118.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,2118.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1548.12,,,2498.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1129.99,,,1384.07,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1548.12,,,2308.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1520.96,,,2444.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1457.09,,,2580.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,28.89,,,28.89,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,28.89,1457.09,
HC PR 47605 CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY,Px00097510823,CDM,47605,CPT,975,RC,,,,BOTH,,,2610,2349,1461.6,,,2349,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1528.86,,,2035.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1631.25,,,2172.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1631.25,,,1330.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1631.25,,,2172.57,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1254.81,,,1330.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1338.24,,,2349,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,2505.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,2035.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,2035.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1487.7,,,2401.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1123.87,,,1330.06,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1487.7,,,2218.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1461.6,,,2349,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1466.54,,,2479.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,147.55,,,147.55,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,147.55,1466.54,
HC SCREW MUC 4.3MM X 46MM SHORT,Sx00044110030,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1530,1377,1453.5,,,1377,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1193.4,,,1193.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1273.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,779.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1273.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,749.7,,,779.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1377,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1468.8,,,1468.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1124.55,,,1193.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,757.2,,,1193.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1407.6,,,1407.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,749.7,,,779.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1300.5,,,1300.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1377,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1453.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,749.7,,,749.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1193.4,1468.8,
HC PR 27125 PARTIAL HIP REPLACEMENT,Px00096910746,CDM,27125,CPT,975,RC,,,,BOTH,,,2683,2414.7,1502.48,,,2414.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1437.96,,,2092.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1676.88,,,2233.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1676.88,,,1367.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1676.88,,,2233.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1280.97,,,1367.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1351.6,,,2414.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1475.65,,,2575.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,2092.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,2092.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1529.31,,,2468.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1147.31,,,1367.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1529.31,,,2280.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1502.48,,,2414.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1470.15,,,2548.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,81.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,81.37,1470.15,
"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, SCLP ARM LEG CDM",Px00045010396,CDM,13121,CPT,450,RC,,,,OUTPATIENT,,,1554,1105.2,1476.3,,,1215.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.12,,,1053.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1124.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,688.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1124.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,688.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1215.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1491.84,,,1296.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1142.19,,,1053.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,769.07,,,1053.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1429.68,,,1242.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,688.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1320.9,,,1148.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1476.3,,,1215.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1283.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,761.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1212.12,1491.84,
HC PLATELET PHERESIS LEUKOREDUCED,Px00039010031,CDM,P9035,CPT,390,RC,,,,BOTH,,,1554,729,1476.3,,,1398.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.12,,,1212.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1293.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,791.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1293.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,791.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1398.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1491.84,,,1491.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1142.19,,,1212.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,769.07,,,1212.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1429.68,,,1429.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,791.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1320.9,,,1320.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1476.3,,,1398.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.6,,,1476.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,761.46,,,761.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1212.12,1491.84,
HC AUTOFIX COMPR SCREW MOD T7 2.0 X 20MM,Sx000141-2020,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1557,1401.3,1479.15,,,1401.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1214.46,,,1214.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.3,,,1296.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.3,,,793.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.3,,,1296.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.93,,,793.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1401.3,,,1401.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1494.72,,,1494.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1144.4,,,1214.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,770.56,,,1214.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1432.44,,,1432.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.93,,,793.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1323.45,,,1323.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1479.15,,,1401.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.3,,,1479.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,762.93,,,762.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1214.46,1494.72,
HC FIBERSTITCH 24 DEG CURVE 2-0 FIBERWIRE SUTURE W/TWO POLYESTER IMPLANTS,Sx0AR-4570-24,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,1559.25,1403.33,1481.29,,,1403.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1216.22,,,1216.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1403.33,,,1297.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1403.33,,,794.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1403.33,,,1297.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.03,,,794.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1403.33,,,1403.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1496.88,,,1496.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1146.05,,,1216.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,771.67,,,1216.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1434.51,,,1434.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.03,,,794.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1325.36,,,1325.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1481.29,,,1403.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1403.33,,,1481.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.03,,,764.03,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1216.22,1496.88,
HC T-PLATE 2.3M HANDLOCK ROT 5H PROFYLE,Sx00057-15385,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1560,1404,1482,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1216.8,,,1216.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,1298.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,794.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,1298.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.4,,,794.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1497.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1146.6,,,1216.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,772.04,,,1216.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1435.2,,,1435.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.4,,,794.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1326,,,1326,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1482,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,1482,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,764.4,,,764.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1216.8,1497.6,
HC ED CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM,Px00045010370,CDM,12020,CPT,450,RC,,,,OUTPATIENT,,,1563,1111.5,1484.85,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.14,,,1060.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.7,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.7,,,692.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.7,,,1131.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.87,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1406.7,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1500.48,,,1304.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.81,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,773.53,,,1060.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1437.96,,,1250.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.87,,,692.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1328.55,,,1155.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1484.85,,,1223.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.7,,,1291.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,765.87,,,765.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1219.14,1500.48,
"HC PR 27446 PLASTY KNEE,MED OR LAT COMPARTMT [27446] CDM",Px00097500049,CDM,27446,CPT,975,RC,,,,BOTH,,,2728,2455.2,1527.68,,,2455.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1461.91,,,2127.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1705,,,2248.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1705,,,1302.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1705,,,2248.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1297.37,,,1302.01,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1381.88,,,2455.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1500.4,,,1580.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,2127.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,2127.84,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1554.96,,,2509.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1161.99,,,1390.19,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1554.96,,,2318.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1527.68,,,2455.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1504.35,,,2591.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,401.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,401.36,1504.35,
HC PR 36561 INSERT TUNNELED CV CATH W/PORT > 5,Px00097510986,CDM,36561,CPT,975,RC,,,,BOTH,,,783,704.7,438.48,,,704.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,426.64,,,610.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.38,,,644.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.38,,,368.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,489.38,,,644.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,365.46,,,368.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,404.17,,,704.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,430.65,,,489.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.79,,,610.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,317.79,,,610.74,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,446.31,,,720.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,327.32,,,399.02,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,446.31,,,665.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,438.48,,,704.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1508.85,,,743.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,317.79,,,317.79,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,317.79,1508.85,
HC ACL TIGHTROPE W/FIBERTAG,Sx0AR-1588RTT,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1575,1417.5,1496.25,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.5,,,1228.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1311.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,802.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1311.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,802.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1512,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.63,,,1228.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,779.47,,,1228.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1449,,,1449,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,802.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1338.75,,,1338.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1496.25,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1496.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,771.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1228.5,1512,
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,Px00036111124,CDM,32554,CPT,361,RC,,,,BOTH,,,1575,1417.5,1496.25,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1228.5,,,1228.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1311.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,802.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1311.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,802.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1512,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.63,,,1228.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,779.47,,,1228.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1449,,,1449,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,802.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1338.75,,,1338.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1496.25,,,1417.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.5,,,1496.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,771.75,,,771.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1228.5,1512,
"HC ED REPAIR OF WOUND/LESION 2.6-7.5CM CMPLX, FRHD CKS SHN MTH NK AX CDM",Px00045010501,CDM,13132,CPT,450,RC,,,,OUTPATIENT,,,1578,1122.3,1499.1,,,1234.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1230.84,,,1070.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1420.2,,,1142.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1420.2,,,699.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1420.2,,,1142.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,773.22,,,699.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1420.2,,,1234.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1514.88,,,1317.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1159.83,,,1070.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,780.95,,,1070.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1451.76,,,1262.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,773.22,,,699.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1341.3,,,1166.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1499.1,,,1234.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1420.2,,,1303.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,773.22,,,773.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1230.84,1514.88,
REMDESIVIR FOR IV SOLN 100 MG,Rx61958290102,CDM,J0248,HCPCS,636,RC,61958290102,NDC,,BOTH,100,ME,1580.67,1356.16,1501.64,,,1422.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1232.92,,,1232.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.6,,,1315.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.6,,,805.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.6,,,1315.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,774.53,,,805.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1422.6,,,1422.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1517.44,,,1517.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1161.79,,,1232.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,774.53,,,1232.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1454.22,,,1454.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,774.53,,,805.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1343.57,,,1343.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.64,,,1422.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1422.6,,,1501.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,774.53,,,774.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1232.92,1517.44,
HC CT ANGIOGRAPHY NECK W CONTRAST,Px00035010010,CDM,70498,CPT,350,RC,,,,BOTH,,,1595,1435.5,1515.25,,,1435.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1244.1,,,1244.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,1327.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,812.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,1327.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,781.55,,,812.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,1435.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1531.2,,,1531.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1172.33,,,1244.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,789.37,,,1244.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1467.4,,,1467.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,781.55,,,812.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1355.75,,,1355.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1515.25,,,1435.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.5,,,1515.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,781.55,,,781.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1244.1,1531.2,
HC VENTRIO PATCH LG OVAL 5.4X7 IN WAS KUGEL,Sx00005950050,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1599.9,1439.91,1519.91,,,1439.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1247.92,,,1247.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.91,,,1331.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.91,,,815.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.91,,,1331.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.95,,,815.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1439.91,,,1439.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1535.9,,,1535.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1175.93,,,1247.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,791.79,,,1247.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1471.91,,,1471.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.95,,,815.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1359.92,,,1359.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1519.91,,,1439.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1439.91,,,1519.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,783.95,,,783.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1247.92,1535.9,
HC CT ANGIOGRAPHY HEAD W CONTRAST,Px00035110032,CDM,70496,CPT,350,RC,,,,BOTH,,,1601,1440.9,1520.95,,,1440.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1248.78,,,1248.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1440.9,,,1332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1440.9,,,815.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1440.9,,,1332.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.49,,,815.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1440.9,,,1440.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.96,,,1536.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176.74,,,1248.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,792.33,,,1248.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1472.92,,,1472.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.49,,,815.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1360.85,,,1360.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1520.95,,,1440.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1440.9,,,1520.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,784.49,,,784.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1248.78,1536.96,
HC CT ORBIT/EAR/FOSSA W CONTRAST,Px00035110017,CDM,70481,CPT,350,RC,,,,BOTH,,,1609,1448.1,1528.55,,,1448.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1255.02,,,1255.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.1,,,1339.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.1,,,819.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.1,,,1339.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,788.41,,,819.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1448.1,,,1448.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1544.64,,,1544.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.62,,,1255.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,796.29,,,1255.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1480.28,,,1480.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,788.41,,,819.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1367.65,,,1367.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1528.55,,,1448.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.1,,,1528.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,788.41,,,788.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1255.02,1544.64,
HC ED THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING CDM,Px00045010068,CDM,32554,CPT,450,RC,,,,OUTPATIENT,,,1615,1148.4,1534.25,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1259.7,,,1095.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1168.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,715.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1168.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,715.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1550.4,,,1347.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1187.03,,,1095.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,799.26,,,1095.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485.8,,,1291.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,715.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1372.75,,,1193.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1534.25,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1333.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,791.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1259.7,1550.4,
HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM,Px00045010787,CDM,32555,CPT,450,RC,,,,OUTPATIENT,,,1615,1148.4,1534.25,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1259.7,,,1095.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1168.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,715.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1168.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,715.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1550.4,,,1347.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1187.03,,,1095.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,799.26,,,1095.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485.8,,,1291.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,715.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1372.75,,,1193.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1534.25,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1453.5,,,1333.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,791.35,,,791.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1259.7,1550.4,
FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION),Rx70710147801,CDM,J1451,HCPCS,636,RC,70710147801,NDC,,BOTH,1,ML,1619.46,1648.22,1538.49,,,1313.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1263.18,,,1138.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1457.51,,,1214.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1457.51,,,743.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1457.51,,,1214.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.54,,,743.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1457.51,,,1313.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1554.68,,,1400.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.3,,,1138.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,793.54,,,1138.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1489.9,,,1342.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.54,,,743.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1376.54,,,1240.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1538.49,,,1313.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1457.51,,,1386.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.54,,,793.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1263.18,1554.68,
HC T-PLATE 2.3 M HANDLOCK REG 7H PROFYLE,Sx00057-15360,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1620,1458,1539,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1263.6,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1348.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,825.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1348.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,825.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1555.2,,,1555.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.7,,,1263.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,801.74,,,1263.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1490.4,,,1490.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,825.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1377,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1539,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1539,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,793.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1263.6,1555.2,
HC PLATE 3X2H 1.7 S HANDLOCK 3-D PROFYLE,Sx00057-10391,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1620,1458,1539,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1263.6,,,1263.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1348.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,825.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1348.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,825.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1555.2,,,1555.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.7,,,1263.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,801.74,,,1263.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1490.4,,,1490.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,825.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1377,,,1377,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1539,,,1458,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1458,,,1539,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,793.8,,,793.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1263.6,1555.2,
HC CT CHEST SPINE WO & W CONTRAST,Px00035210013,CDM,72130,CPT,350,RC,,,,BOTH,,,1623,1460.7,1541.85,,,1460.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1265.94,,,1265.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.7,,,1350.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.7,,,827.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.7,,,1350.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,795.27,,,827.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1460.7,,,1460.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1558.08,,,1558.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1192.91,,,1265.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,803.22,,,1265.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1493.16,,,1493.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,795.27,,,827.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1379.55,,,1379.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1541.85,,,1460.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.7,,,1541.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,795.27,,,795.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1265.94,1558.08,
HC CT ANGIOGRAPHY CHEST,Px00035010013,CDM,71275,CPT,350,RC,,,,BOTH,,,1628,1465.2,1546.6,,,1465.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269.84,,,1269.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1465.2,,,1355.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1465.2,,,829.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1465.2,,,1355.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,797.72,,,829.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1465.2,,,1465.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1562.88,,,1562.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.58,,,1269.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,805.7,,,1269.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1497.76,,,1497.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,797.72,,,829.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1383.8,,,1383.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1546.6,,,1465.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1465.2,,,1546.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,797.72,,,797.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1269.84,1562.88,
HC MRI UPPER EXTREMITY JOINT WO CONTRAST,Px00061010063,CDM,73221,CPT,610,RC,,,,BOTH,,,1642,1477.8,1559.9,,,1477.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1280.76,,,1280.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1366.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,836.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1366.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,836.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1477.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1576.32,,,1576.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1206.87,,,1280.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,1280.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1510.64,,,1510.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,836.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1395.7,,,1395.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.9,,,1477.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1559.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,804.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1280.76,1576.32,
HC MRI LOWER EXTREMITY JOINT WO CONTRAST,Px00061010075,CDM,73721,CPT,610,RC,,,,BOTH,,,2250,1477.8,1559.9,,,2025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1280.76,,,1755,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1867.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1147.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,1867.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,1147.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,2025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1576.32,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1206.87,,,1755,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,1755,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1510.64,,,2070,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,1147.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1395.7,,,1912.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.9,,,2025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1477.8,,,2137.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,804.58,,,1102.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1280.76,1576.32,
HC PACU ACUITY 4,Px00071010230,CDM,,,710,RC,,,,BOTH,,,1645,1480.5,1562.75,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1283.1,,,1283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1480.5,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1480.5,,,838.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1480.5,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,806.05,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1480.5,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1579.2,,,1579.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1209.08,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,806.05,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1513.4,,,1513.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,806.05,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1398.25,,,1398.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1562.75,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1480.5,,,1562.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,806.05,,,806.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1283.1,1579.2,
HC HEADLESS COMPRESSION SCREW 4MM 50MM LONG,Sx00000658050,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1650,1485,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287,,,1287,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,840.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1584,,,1584,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.75,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816.59,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1518,,,1518,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1402.5,,,1402.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1567.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,808.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1287,1584,
HC HEADLESS COMPRESS SCR 4X60MM,Sx00000658060,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1650,1485,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287,,,1287,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,840.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1584,,,1584,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.75,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816.59,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1518,,,1518,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1402.5,,,1402.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1567.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,808.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1287,1584,
HC LOCK DISTAL FIBULA PLATE STAINLESS LEFT 4 HOLE,SxAR-8943BL-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1650,1485,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287,,,1287,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,840.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1584,,,1584,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.75,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816.59,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1518,,,1518,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1402.5,,,1402.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1567.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,808.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1287,1584,
HC OPERATING ROOM SERVICES LEVEL 1,Px00036010021,CDM,,,360,RC,,,,BOTH,,,1650,1485,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1287,,,1287,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,840.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1584,,,1584,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1212.75,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,816.59,,,1287,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1518,,,1518,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,840.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1402.5,,,1402.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1567.5,,,1485,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1485,,,1567.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,808.5,,,808.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1287,1584,
HC PR 27245 TX FEMORAL FRACTURE W/INTRAMEDULARY TYPE IMPLANT,Px00096910752,CDM,27245,CPT,983,RC,,,,BOTH,,,2908,2617.2,1628.48,,,2617.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1557.66,,,2268.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1817.5,,,2420.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1817.5,,,1481.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1817.5,,,2420.62,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1386.49,,,1481.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1467.61,,,2617.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1599.4,,,2791.68,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,483.38,,,2268.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,483.38,,,2268.24,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1657.56,,,2675.36,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1241.81,,,1481.92,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1657.56,,,2471.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1628.48,,,2617.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1597.04,,,2762.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,483.38,,,483.38,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,483.38,1597.04,
HC ED FAC E&M VISIT LEVEL 5 CDM,Px00045010216,CDM,99285,CPT,450,RC,,,,OUTPATIENT,,,1664,1183.5,1580.8,,,1302.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1297.92,,,1128.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1204.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,737.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1204.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,737.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1302.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1597.44,,,1389.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.04,,,1128.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,823.51,,,1128.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1530.88,,,1331.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,737.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1414.4,,,1229.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1580.8,,,1302.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1374.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,815.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1297.92,1597.44,
HC CT LWR EXTREMITY WO & W CONTRAST,Px00035010018,CDM,73702,CPT,350,RC,,,,BOTH,,,1664,1497.6,1580.8,,,1497.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1297.92,,,1297.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1385.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,847.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1385.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,847.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1497.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1597.44,,,1597.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1223.04,,,1297.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,823.51,,,1297.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1530.88,,,1530.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,847.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1414.4,,,1414.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1580.8,,,1497.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1497.6,,,1580.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,815.36,,,815.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1297.92,1597.44,
HC VARIAX COMPRESSION PLATE 7 HOLE/L90 MM 2 LOCKING HOLES,Sx0000629507S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1668,1501.2,1584.6,,,1501.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1301.04,,,1301.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.2,,,1388.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.2,,,850.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.2,,,1388.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,817.32,,,850.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1501.2,,,1501.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1601.28,,,1601.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1225.98,,,1301.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,825.49,,,1301.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1534.56,,,1534.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,817.32,,,850.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1417.8,,,1417.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1584.6,,,1501.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.2,,,1584.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,817.32,,,817.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1301.04,1601.28,
HC PLT PHERESIS LR IRR CMV NEG,Px00039010040,CDM,P9053,CPT,390,RC,,,,BOTH,,,1680,1512,1596,,,1512,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1310.4,,,1310.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1398.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,856.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1398.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.2,,,856.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1512,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1612.8,,,1612.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1310.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.43,,,1310.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1545.6,,,1545.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.2,,,856.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1428,,,1428,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1596,,,1512,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512,,,1596,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.2,,,823.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1310.4,1612.8,
HC CTA PELV WO & W CONTRAST,Px00035210017,CDM,72191,CPT,350,RC,,,,BOTH,,,1681,1512.9,1596.95,,,1512.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.18,,,1311.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.9,,,1399.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.9,,,856.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.9,,,1399.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.69,,,856.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1512.9,,,1512.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.76,,,1613.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1235.54,,,1311.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,831.93,,,1311.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1546.52,,,1546.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.69,,,856.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1428.85,,,1428.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1596.95,,,1512.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.9,,,1596.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,823.69,,,823.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1311.18,1613.76,
HC CTA ABDOMEN WO & W CONTRAST,Px00035010023,CDM,74175,CPT,350,RC,,,,BOTH,,,1689,1520.1,1604.55,,,1520.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.42,,,1317.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1520.1,,,1405.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1520.1,,,860.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1520.1,,,1405.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,827.61,,,860.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1520.1,,,1520.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1621.44,,,1621.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1241.42,,,1317.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,835.89,,,1317.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1553.88,,,1553.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,827.61,,,860.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1435.65,,,1435.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1604.55,,,1520.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1520.1,,,1604.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,827.61,,,827.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1317.42,1621.44,
HC HARVESTER BONE GRAFT OSTEOAUGER 10MM,SxABS-8000-10,CDM,,,270,RC,,,,BOTH,,,1695,1525.5,1610.25,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1322.1,,,1322.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1410.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,863.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1410.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,863.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1627.2,,,1627.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1245.83,,,1322.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.86,,,1322.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1559.4,,,1559.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,863.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1440.75,,,1440.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1610.25,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1610.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,830.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1322.1,1627.2,
HC HARVESTER BONE GRAFT OSTEOAUGER 8MM,SxABS-8000-08,CDM,,,270,RC,,,,BOTH,,,1695,1525.5,1610.25,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1322.1,,,1322.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1410.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,863.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1410.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,863.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1627.2,,,1627.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1245.83,,,1322.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,838.86,,,1322.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1559.4,,,1559.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,863.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1440.75,,,1440.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1610.25,,,1525.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.5,,,1610.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,830.55,,,830.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1322.1,1627.2,
HC PR 59515 CESAREAN DELIVERY ONLY W/POSTPARTUM CARE,Px00097511319,CDM,59515,CPT,975,RC,,,,BOTH,,,3136,2822.4,1756.16,,,2822.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1417.21,,,2446.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1960,,,2610.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1960,,,1598.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1960,,,2610.41,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1470.78,,,1598.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1493.07,,,2822.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1724.8,,,3010.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,2446.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,2446.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1787.52,,,2885.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1317.31,,,1598.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1787.52,,,2665.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1756.16,,,2822.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1642.5,,,2979.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,170.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,170.28,1642.5,
HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML,Rx13533063650,CDM,90371,CPT,636,RC,13533063650,NDC,,BOTH,1,ML,1716.77,1545.09,1630.93,,,1630.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1339.08,,,1339.08,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1545.09,,,1545.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1545.09,,,1545.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1545.09,,,1545.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,841.22,,,841.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1545.09,,,1545.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1648.1,,,1648.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1261.83,,,1261.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,841.22,,,841.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1579.43,,,1579.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,841.22,,,841.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1459.25,,,1459.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1630.93,,,1630.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1545.09,,,1545.09,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,841.22,,,841.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1339.08,1648.1,
HC CT ABDOMEN & PELVIS W  CONTRAST,Px00035010025,CDM,74177,CPT,350,RC,,,,BOTH,,,2600,1545.3,1631.15,,,2340,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1339.26,,,2028,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,2158,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,1326,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,2158,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,841.33,,,1326,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,2340,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1648.32,,,2496,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1262,,,2028,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,849.74,,,2028,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1579.64,,,2392,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,841.33,,,1326,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1459.45,,,2210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1631.15,,,2340,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,2470,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,841.33,,,1274,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1339.26,1648.32,
HC PLATELET PHERESIS LEUKOREDU IRRAD,Px00039010033,CDM,P9037,CPT,390,RC,,,,BOTH,,,1724,1512,1637.8,,,1551.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1344.72,,,1344.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1551.6,,,1435.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1551.6,,,878.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1551.6,,,1435.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,844.76,,,878.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1551.6,,,1551.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1655.04,,,1655.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1267.14,,,1344.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,853.21,,,1344.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1586.08,,,1586.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,844.76,,,878.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1465.4,,,1465.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1637.8,,,1551.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1551.6,,,1637.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,844.76,,,844.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1344.72,1655.04,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML,Rx13533080071,CDM,J1561,HCPCS,636,RC,13533080071,NDC,,BOTH,100,ML,1724.88,1921.36,1638.64,,,1638.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1345.41,,,1345.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1552.39,,,1552.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1552.39,,,1552.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1552.39,,,1552.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,845.19,,,845.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1552.39,,,1552.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1655.88,,,1655.88,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1267.79,,,1267.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,845.19,,,845.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1586.89,,,1586.89,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,845.19,,,845.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1466.15,,,1466.15,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1638.64,,,1638.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1552.39,,,1552.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,845.19,,,845.19,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1345.41,1655.88,
HC GELPORT HAND ACCESS 120MM,Sx004160C8XX2,CDM,,,270,RC,,,,BOTH,,,1725,1552.5,1638.75,,,1552.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.5,,,1345.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1552.5,,,1435.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1552.5,,,879.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1552.5,,,1435.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,845.25,,,879.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1552.5,,,1552.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1656,,,1656,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1267.88,,,1345.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,853.7,,,1345.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1587,,,1587,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,845.25,,,879.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1466.25,,,1466.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1638.75,,,1552.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1552.5,,,1638.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,845.25,,,845.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1345.5,1656,
HC SCREW DRILL CANNULATED HIP 10.3MM,Sx0000258-000,CDM,,,270,RC,,,,BOTH,,,1732.5,1559.25,1645.88,,,1559.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1351.35,,,1351.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.25,,,1442.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.25,,,882.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.25,,,1442.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,848.93,,,882.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1559.25,,,1559.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1663.2,,,1663.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1273.39,,,1351.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,857.41,,,1351.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1593.9,,,1593.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,848.93,,,882.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1472.63,,,1472.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1645.88,,,1559.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1559.25,,,1645.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,848.93,,,848.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1351.35,1663.2,
HC PR 36573 INSERTION PICC W/RS&I 5 YR/>,Px00097511291,CDM,36573,CPT,975,RC,,,,BOTH,,,195,175.5,109.2,,,175.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.12,,,152.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.88,,,160.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.88,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,121.88,,,160.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,91.59,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.27,,,175.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,107.25,,,187.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.64,,,152.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,79.64,,,152.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,179.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,82.03,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,111.15,,,165.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,109.2,,,175.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1673.09,,,185.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,79.64,,,79.64,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,79.64,1673.09,
HC PR 36573 INSERTION PICC W/RS&I 5 YR/> CDM,Px00096300038,CDM,36573,CPT,963,RC,,,,BOTH,,,1124,1011.6,629.44,,,1011.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,106.12,,,876.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,702.5,,,815.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,702.5,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,702.5,,,815.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,528.28,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,101.27,,,1011.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.38,,,1079.04,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,606.96,,,876.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,528.28,,,876.72,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,116.38,,,1034.08,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,533.9,,,91.93,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,640.68,,,955.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,629.44,,,1011.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1673.09,,,1067.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,69.09,,,69.09,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,528.28,1673.09,
HC OPERATING ROOM SERVICES LEVEL 2,Px00036010022,CDM,,,360,RC,,,,BOTH,,,1765,1588.5,1676.75,,,1588.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1376.7,,,1376.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1588.5,,,1469.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1588.5,,,899.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1588.5,,,1469.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864.85,,,899.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1588.5,,,1588.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1694.4,,,1694.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1297.28,,,1376.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,873.5,,,1376.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1623.8,,,1623.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864.85,,,899.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1500.25,,,1500.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1676.75,,,1588.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1588.5,,,1676.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,864.85,,,864.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1376.7,1694.4,
HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML,Rx13533063605,CDM,90371,CPT,636,RC,13533063605,NDC,,BOTH,1,ML,1767.15,1590.44,1678.79,,,1590.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1378.38,,,1378.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1590.44,,,1470.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1590.44,,,900.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1590.44,,,1470.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,865.9,,,900.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1590.44,,,1590.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1696.46,,,1696.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1298.86,,,1378.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,865.9,,,1378.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1625.78,,,1625.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,865.9,,,900.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1502.08,,,1502.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1678.79,,,1590.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1590.44,,,1678.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,865.9,,,865.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1378.38,1696.46,
HC HEPATITIS C GENOTYPING,Px00030211015,CDM,87902,CPT,300,RC,,,,BOTH,,,1793,1613.7,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.54,,,1398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,913.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.28,,,1721.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.86,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.36,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1649.56,,,1649.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1524.05,,,1524.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1703.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,878.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1398.54,1721.28,
HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS #,Px00030600409,CDM,87902,CPT,300,RC,,,,BOTH,,,1793,1613.7,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.54,,,1398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,913.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.28,,,1721.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.86,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.36,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1649.56,,,1649.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1524.05,,,1524.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1703.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,878.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1398.54,1721.28,
HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS #,Px00030600410,CDM,87902,CPT,300,RC,,,,BOTH,,,1793,1613.7,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.54,,,1398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,913.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.28,,,1721.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.86,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.36,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1649.56,,,1649.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1524.05,,,1524.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1703.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,878.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1398.54,1721.28,
HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS #,Px00030600411,CDM,87902,CPT,300,RC,,,,BOTH,,,1793,1613.7,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.54,,,1398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,913.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.28,,,1721.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.86,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.36,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1649.56,,,1649.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1524.05,,,1524.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1703.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,878.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1398.54,1721.28,
HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS #,Px00030600418,CDM,87902,CPT,300,RC,,,,BOTH,,,1793,1613.7,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1398.54,,,1398.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,913.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1492.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.28,,,1721.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1317.86,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,887.36,,,1398.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1649.56,,,1649.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,913.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1524.05,,,1524.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1703.35,,,1613.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1613.7,,,1703.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,878.57,,,878.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1398.54,1721.28,
HC LIGASURE IMPACT CURVED LG JAW,Sx00000LF4418,CDM,,,270,RC,,,,BOTH,,,1796.94,1617.25,1707.09,,,1617.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.61,,,1401.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617.25,,,1495.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617.25,,,915.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617.25,,,1495.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.5,,,915.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1617.25,,,1617.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1725.06,,,1725.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1320.75,,,1401.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,889.31,,,1401.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1653.18,,,1653.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.5,,,915.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1527.4,,,1527.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.09,,,1617.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617.25,,,1707.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,880.5,,,880.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1401.61,1725.06,
HC SECONDARY FIXATION KIT ACL/PCL REPAIR,Sx0000AR-1593,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1800,1620,1710,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1404,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620,,,917.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1620,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1728,,,1728,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,890.82,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1656,,,1656,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1530,,,1530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1710,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620,,,1710,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882,,,882,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1404,1728,
HC ALLOGRAFT HUMAN TISSUE EPIFIX 18MM - DISK,Sx0000GS-5180,CDM,Q4186,HCPCS,278,RC,,,,BOTH,,,1801.5,1621.35,1711.43,,,1621.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1405.17,,,1405.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1621.35,,,1499.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1621.35,,,918.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1621.35,,,1499.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.74,,,918.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1621.35,,,1621.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1729.44,,,1729.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1324.1,,,1405.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,891.56,,,1405.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1657.38,,,1657.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.74,,,918.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1531.28,,,1531.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1711.43,,,1621.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1621.35,,,1711.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,882.74,,,882.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1405.17,1729.44,
HC PACU ACUITY LVL 5 INITIAL,Px00071010010,CDM,,,710,RC,,,,BOTH,,,1810,1629,1719.5,,,1629,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1411.8,,,1411.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1629,,,1506.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1629,,,922.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1629,,,1506.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.9,,,922.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1629,,,1629,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1737.6,,,1737.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1330.35,,,1411.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,886.9,,,1411.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1665.2,,,1665.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.9,,,922.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1538.5,,,1538.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1719.5,,,1629,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1629,,,1719.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,886.9,,,886.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1411.8,1737.6,
HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< CDM,Px00045010035,CDM,11400,CPT,450,RC,,,,OUTPATIENT,,,1817,1292.4,1726.15,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.26,,,1232.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1172.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1172.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1744.32,,,106.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1335.5,,,1232.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,899.23,,,1232.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1671.64,,,1453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,805.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1544.45,,,1343,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1726.15,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1501,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,890.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1417.26,1744.32,
HC ED DRAIN OUTER EAR CANAL LESION CDM,Px00045013173,CDM,69020,CPT,450,RC,,,,OUTPATIENT,,,1817,1292.4,1726.15,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.26,,,1232.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1315.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,805.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1315.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,805.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1744.32,,,1516.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1335.5,,,1232.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,899.23,,,1232.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1671.64,,,1453.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,805.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1544.45,,,1343,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1726.15,,,1422,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1635.3,,,1501,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.33,,,890.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1417.26,1744.32,
HC TRUESPAN MENISCAL RPR 12 DEG JOHNSON&JOHNSON,Sx00000228151,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1818,1636.2,1727.1,,,1636.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1418.04,,,1418.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1636.2,,,1513.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1636.2,,,926.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1636.2,,,1513.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.82,,,926.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1636.2,,,1636.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1745.28,,,1745.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,1418.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,899.73,,,1418.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1672.56,,,1672.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.82,,,926.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1545.3,,,1545.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1727.1,,,1636.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1636.2,,,1727.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,890.82,,,890.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1418.04,1745.28,
DARBEPOETIN ALFA SOLN INJ 100 MCG/ML,Rx55513000501,CDM,J0881,HCPCS,636,RC,55513000501,NDC,,BOTH,1,ML,1825.12,1642.61,1733.86,,,1642.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1423.59,,,1423.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1642.61,,,1519.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1642.61,,,930.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1642.61,,,1519.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.31,,,930.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1642.61,,,1642.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1752.12,,,1752.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1341.46,,,1423.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,894.31,,,1423.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1679.11,,,1679.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.31,,,930.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1551.35,,,1551.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1733.86,,,1642.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1642.61,,,1733.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.31,,,894.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1423.59,1752.12,
OMALIZUMAB FOR INJ 150 MG,Rx50242004062,CDM,J2357,HCPCS,636,RC,50242004062,NDC,,BOTH,150,ME,1825.9,1550.3,1734.61,,,1643.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1424.2,,,1424.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1643.31,,,1519.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1643.31,,,930.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1643.31,,,1519.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.69,,,930.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1643.31,,,1643.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1752.86,,,1752.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1342.04,,,1424.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,894.69,,,1424.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1679.83,,,1679.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.69,,,930.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1552.02,,,1552.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1734.61,,,1643.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1643.31,,,1734.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,894.69,,,894.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1424.2,1752.86,
HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 312 UNIT/ML,Rx69800420301,CDM,90371,CPT,636,RC,69800420301,NDC,,BOTH,1,ML,1828.36,1598.83,1736.94,,,1645.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1426.12,,,1426.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1645.52,,,1522.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1645.52,,,931.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1645.52,,,1522.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.9,,,931.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1645.52,,,1645.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1755.23,,,1755.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1343.84,,,1426.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,895.9,,,1426.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1682.09,,,1682.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.9,,,931.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1554.11,,,1554.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.94,,,1645.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1645.52,,,1737.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,895.9,,,895.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1426.12,1755.23,
HC OPERATING ROOM SERVICES LEVEL 3,Px00036010023,CDM,,,360,RC,,,,BOTH,,,1830,1647,1738.5,,,1647,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1427.4,,,1427.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1647,,,1523.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1647,,,932.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1647,,,1523.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.7,,,932.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1647,,,1647,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1756.8,,,1756.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1345.05,,,1427.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,905.67,,,1427.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1683.6,,,1683.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.7,,,932.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1555.5,,,1555.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1738.5,,,1647,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1647,,,1738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,896.7,,,896.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1427.4,1756.8,
HC PR 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS,Px00097511328,CDM,27447,CPT,975,RC,,,,BOTH,,,3032,2728.8,1697.92,,,2728.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1624.11,,,2364.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1895,,,2500.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1895,,,1450.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1895,,,2500.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1444.98,,,1450.33,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1615.74,,,2728.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1667.6,,,1848.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,2364.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,2364.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1728.24,,,2789.44,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1294.2,,,1545.11,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1728.24,,,2577.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1697.92,,,2728.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1759.95,,,2880.4,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,401.36,,,401.36,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,401.36,1759.95,
HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT,Px00097511325,CDM,27130,CPT,975,RC,,,,BOTH,,,3035,2731.5,1699.6,,,2731.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1626.17,,,2367.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1896.88,,,2502.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1896.88,,,1452.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1896.88,,,2502.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1446.83,,,1452.51,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1617.37,,,2731.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1669.25,,,1849.65,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,2367.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,2367.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1729.95,,,2792.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1295.85,,,1546.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1729.95,,,2579.75,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1699.6,,,2731.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1760.39,,,2883.25,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,81.37,,,81.37,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,81.37,1760.39,
HC ED DRAIN EXTERNAL EAR LESION SIMPLE CDM,Px00045010485,CDM,69000,CPT,450,RC,,,,OUTPATIENT,,,1852,1317.6,1759.4,,,1449,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1444.56,,,1255.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1666.8,,,1340.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1666.8,,,820.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1666.8,,,1340.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.48,,,820.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1666.8,,,1449,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1777.92,,,1545.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1361.22,,,1255.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,916.55,,,1255.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1703.84,,,1481.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.48,,,820.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1574.2,,,1368.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1759.4,,,1449,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1666.8,,,1529.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,907.48,,,907.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1444.56,1777.92,
HC CT ANGIO UPR EXTRM WO & W CONTRAST,Px00035210037,CDM,73206,CPT,350,RC,,,,BOTH,,,1857,1671.3,1764.15,,,1671.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.46,,,1448.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1671.3,,,1545.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1671.3,,,946.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1671.3,,,1545.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909.93,,,946.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1671.3,,,1671.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1782.72,,,1782.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1364.9,,,1448.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,919.03,,,1448.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1708.44,,,1708.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909.93,,,946.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1578.45,,,1578.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764.15,,,1671.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1671.3,,,1764.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,909.93,,,909.93,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1448.46,1782.72,
HC VENTRALEX HERNIA PATCH LARGE 3.2 INCH WITH STRAP,Sx00000010303,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1866.3,1679.67,1772.99,,,1679.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1455.71,,,1455.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.67,,,1553.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.67,,,951.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.67,,,1553.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.49,,,951.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1679.67,,,1679.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1791.65,,,1791.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1371.73,,,1455.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,923.63,,,1455.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1717,,,1717,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.49,,,951.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1586.36,,,1586.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1772.99,,,1679.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.67,,,1772.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,914.49,,,914.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1455.71,1791.65,
HC DRILL BIT 2.5 X 45 MV 4.0,Sx00XFO094501,CDM,,,270,RC,,,,BOTH,,,1872,1684.8,1778.4,,,1684.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.16,,,1460.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1684.8,,,1558.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1684.8,,,953.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1684.8,,,1558.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,917.28,,,953.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1684.8,,,1684.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1797.12,,,1797.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1375.92,,,1460.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,926.45,,,1460.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1722.24,,,1722.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,917.28,,,953.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1591.2,,,1591.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1684.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1684.8,,,1778.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,917.28,,,917.28,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1460.16,1797.12,
HC VENTRIO PATCH LG CIRCLE 4.5DIA WAS KUGEL,Sx00005950020,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,1876.5,1688.85,1782.68,,,1688.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1463.67,,,1463.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1688.85,,,1562,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1688.85,,,956.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1688.85,,,1562,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.49,,,956.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1688.85,,,1688.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1801.44,,,1801.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1379.23,,,1463.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,928.68,,,1463.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1726.38,,,1726.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.49,,,956.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1595.03,,,1595.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1782.68,,,1688.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1688.85,,,1782.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,919.49,,,919.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1463.67,1801.44,
DARBEPOETIN ALFA SOLN INJ 100 MCG/ML,Rx55513000504,CDM,J0881,HCPCS,636,RC,55513000504,NDC,,BOTH,1,ML,1878.15,1691.63,1784.24,,,1784.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1464.96,,,1464.96,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.34,,,1690.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.34,,,1690.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.34,,,1690.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,920.29,,,920.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1690.34,,,1690.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1803.02,,,1803.02,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1380.44,,,1380.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,920.29,,,920.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1727.9,,,1727.9,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,920.29,,,920.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1596.43,,,1596.43,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1784.24,,,1784.24,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.34,,,1690.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,920.29,,,920.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1464.96,1803.02,
HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM,Px00045010107,CDM,62270,CPT,450,RC,,,,OUTPATIENT,,,1889,1344.6,1794.55,,,1478.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1473.42,,,1281.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1700.1,,,1367.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1700.1,,,837.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1700.1,,,1367.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,925.61,,,837.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1700.1,,,1478.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1813.44,,,1577.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1388.42,,,1281.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,934.87,,,1281.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1737.88,,,1511.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,925.61,,,837.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1605.65,,,1396.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.55,,,1478.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1700.1,,,1560.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,925.61,,,925.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1473.42,1813.44,
HC ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH CDM,Px00045014035,CDM,64450,CPT,450,RC,,,,OUTPATIENT,,,1892,1345.5,1797.4,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1475.76,,,1283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,838.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1816.32,,,62.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1390.62,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,936.35,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1740.64,,,1513.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1608.2,,,1398.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1797.4,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1562.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,927.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1475.76,1816.32,
HC ED INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM,Px00045010673,CDM,64447,CPT,450,RC,,,,OUTPATIENT,,,1892,1345.5,1797.4,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1475.76,,,1283.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,838.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1369.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1816.32,,,89.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1390.62,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,936.35,,,1283.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1740.64,,,1513.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,838.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1608.2,,,1398.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1797.4,,,1480.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1702.8,,,1562.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,927.08,,,927.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1475.76,1816.32,
HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE^,Px00036110662,CDM,49083,CPT,361,RC,,,,BOTH,,,1897,1707.3,1802.15,,,1707.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1479.66,,,1479.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.3,,,1579.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.3,,,966.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.3,,,1579.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.53,,,966.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1707.3,,,1707.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1821.12,,,1821.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1394.3,,,1479.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,938.83,,,1479.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1745.24,,,1745.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.53,,,966.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1612.45,,,1612.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1802.15,,,1707.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.3,,,1802.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,929.53,,,929.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1479.66,1821.12,
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM,Px00036100013,CDM,49082,CPT,361,RC,,,,BOTH,,,1907,1716.3,1811.65,,,1716.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1487.46,,,1487.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1716.3,,,1587.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1716.3,,,971.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1716.3,,,1587.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.43,,,971.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1716.3,,,1716.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1830.72,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1401.65,,,1487.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,943.77,,,1487.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1754.44,,,1754.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.43,,,971.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1620.95,,,1620.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1811.65,,,1716.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1716.3,,,1811.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,934.43,,,934.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1487.46,1830.72,
HC BARDPORT MRI 8FR VENOUS CATH 8fr OPEN END/ SINGLE LUMEN,Sx00000607540,CDM,,,270,RC,,,,BOTH,,,1912.86,1721.57,1817.22,,,1721.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.03,,,1492.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.57,,,1592.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.57,,,974.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.57,,,1592.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.3,,,974.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1721.57,,,1721.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1836.35,,,1836.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1405.95,,,1492.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,946.67,,,1492.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1759.83,,,1759.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.3,,,974.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1625.93,,,1625.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1817.22,,,1721.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1721.57,,,1817.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,937.3,,,937.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1492.03,1836.35,
HC 2.3M PROFYLE HAND LOCK Y-PLATE NAR 7 HOLE,Sx00057-15370,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1924.8,1732.32,1828.56,,,1732.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1501.34,,,1501.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1732.32,,,1602.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1732.32,,,980.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1732.32,,,1602.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,943.15,,,980.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1732.32,,,1732.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1847.81,,,1847.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1414.73,,,1501.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,952.58,,,1501.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1770.82,,,1770.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,943.15,,,980.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1636.08,,,1636.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1828.56,,,1732.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1732.32,,,1828.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,943.15,,,943.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1501.34,1847.81,
HC REAMER SHAFT MOD TRINKLE 8.0X448MM STERILE,Sx00227-3000S,CDM,,,270,RC,,,,BOTH,,,1929,1736.1,1832.55,,,1736.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.62,,,1504.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.1,,,1605.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.1,,,983.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.1,,,1605.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945.21,,,983.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1736.1,,,1736.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1851.84,,,1851.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1417.82,,,1504.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,954.66,,,1504.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1774.68,,,1774.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945.21,,,983.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1639.65,,,1639.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1832.55,,,1736.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.1,,,1832.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,945.21,,,945.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1504.62,1851.84,
HC INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM,Px00036111070,CDM,64417,CPT,761,RC,,,,BOTH,,,1937,1743.3,1840.15,,,1743.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1510.86,,,1510.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1743.3,,,1612.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1743.3,,,987.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1743.3,,,1612.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.13,,,987.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1743.3,,,1743.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1859.52,,,1859.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1423.7,,,1510.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,949.13,,,1510.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1782.04,,,1782.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.13,,,987.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1646.45,,,1646.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.15,,,1743.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1743.3,,,1840.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,949.13,,,949.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1510.86,1859.52,
HC LOCK DISTAL FIBULA PLATE STAINLESS RIGHT 5 HOLE,SxAR-8943BR-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,1950,1755,1852.5,,,1755,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1521,,,1521,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1755,,,1623.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1755,,,993.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1755,,,1623.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.5,,,993.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1755,,,1755,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1872,,,1872,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1521,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,965.06,,,1521,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1794,,,1794,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.5,,,993.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1657.5,,,1657.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1852.5,,,1755,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1755,,,1852.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,955.5,,,955.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1521,1872,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML,Rx13533080072,CDM,J1561,HCPCS,636,RC,13533080072,NDC,,BOTH,100,ML,1953.05,1757.75,1855.4,,,1757.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1523.38,,,1523.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1757.75,,,1625.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1757.75,,,995.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1757.75,,,1625.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,956.99,,,995.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1757.75,,,1757.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1874.93,,,1874.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1435.49,,,1523.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,956.99,,,1523.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1796.81,,,1796.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,956.99,,,995.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1660.09,,,1660.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1855.4,,,1757.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1757.75,,,1855.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,956.99,,,956.99,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1523.38,1874.93,
HC OPERATING ROOM SERVICES LEVEL 4,Px00036010024,CDM,,,360,RC,,,,BOTH,,,1965,1768.5,1866.75,,,1768.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1532.7,,,1532.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1768.5,,,1635.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1768.5,,,1001.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1768.5,,,1635.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,962.85,,,1001.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1768.5,,,1768.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1886.4,,,1886.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1444.28,,,1532.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,972.48,,,1532.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1807.8,,,1807.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,962.85,,,1001.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1670.25,,,1670.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1866.75,,,1768.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1768.5,,,1866.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,962.85,,,962.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1532.7,1886.4,
HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,Px00097511300,CDM,23472,CPT,975,RC,,,,BOTH,,,3417,3075.3,1913.52,,,3075.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1832.8,,,2665.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2135.63,,,2817.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2135.63,,,1634.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2135.63,,,2817.54,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1626.72,,,1634.22,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1735.46,,,3075.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1879.35,,,1987.88,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,2665.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,2665.26,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1947.69,,,3143.64,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1456.98,,,1741.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1947.69,,,2904.45,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1913.52,,,3075.3,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,3246.15,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,47.95,,,47.95,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,47.95,1890,
HC CT ABDOMEN & PELVIS W WO CONTRAST,Px00035210054,CDM,74178,CPT,350,RC,,,,BOTH,,,1971,1773.9,1872.45,,,1773.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1537.38,,,1537.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.9,,,1640.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.9,,,1004.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.9,,,1640.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,965.79,,,1004.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1773.9,,,1773.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1892.16,,,1892.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1448.69,,,1537.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,975.45,,,1537.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1813.32,,,1813.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,965.79,,,1004.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1675.35,,,1675.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1872.45,,,1773.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.9,,,1872.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,965.79,,,965.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1537.38,1892.16,
HC MYOSURE LITE TISSUE REMOVAL DEVICE,Sx030-403LITE,CDM,,,270,RC,,,,BOTH,,,1976,1778.4,1877.2,,,1778.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1541.28,,,1541.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1644.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1006.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1644.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.24,,,1006.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1778.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1896.96,,,1896.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1452.36,,,1541.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,977.92,,,1541.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1817.92,,,1817.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.24,,,1006.97,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1679.6,,,1679.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1877.2,,,1778.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1778.4,,,1877.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,968.24,,,968.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1541.28,1896.96,
HC R&B-SEMI-PRIVATE OTHER SWING BED,Px00012910003,CDM,,,129,RC,,,,INPATIENT,,,2000,292.5,1900,,,1900,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1560,,,1560,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1800,,,1800,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1800,,,1800,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1800,,,1800,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,,,0.01,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1800,,,1800,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1920,,,1920,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,,,0.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,,,0.01,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1840,,,1840,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,,,0.01,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1700,,,1700,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1900,,,1900,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1800,,,1800,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,0.01,,,3970.51,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1560,1920,
HC INTRA ACUITY PER HR CLASS 3,Px00072010074,CDM,,,720,RC,,,,BOTH,,,2045,1276.2,1942.75,,,1531.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1595.1,,,1327.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.5,,,1416.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.5,,,867.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.5,,,1416.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.05,,,867.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1840.5,,,1531.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1963.2,,,1633.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.08,,,1327.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1002.05,,,1327.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1881.4,,,1565.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.05,,,867.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1738.25,,,1446.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1942.75,,,1531.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.5,,,1616.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1002.05,,,1002.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1595.1,1963.2,
HC OPERATING ROOM SERVICES LEVEL 5,Px00036010025,CDM,,,360,RC,,,,BOTH,,,2085,1876.5,1980.75,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1626.3,,,1626.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1876.5,,,1735.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1876.5,,,1062.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1876.5,,,1735.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1021.65,,,1062.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1876.5,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2001.6,,,2001.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1532.48,,,1626.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1031.87,,,1626.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1918.2,,,1918.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1021.65,,,1062.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1772.25,,,1772.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1980.75,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1876.5,,,1980.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1021.65,,,1021.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1626.3,2001.6,
HC MESH PRIMATRIX 3X3 HCPCS Q4110,Sx607-005-330,CDM,Q4118,HCPCS,278,RC,,,,BOTH,,,2091.99,1726.19,1987.39,,,1882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1631.75,,,1631.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.79,,,1741.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.79,,,1066.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.79,,,1741.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.08,,,1066.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1882.79,,,1882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2008.31,,,2008.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1537.61,,,1631.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1035.33,,,1631.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1924.63,,,1924.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.08,,,1066.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1778.19,,,1778.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1987.39,,,1882.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.79,,,1987.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1025.08,,,1025.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1631.75,2008.31,
HC LOCKING LATERAL HOOK PL 3 HOLE,SxAR-8943TH-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2100,1890,1995,,,1890,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1638,,,1638,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,1748.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,1070.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,1748.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1029,,,1070.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,1890,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2016,,,2016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1543.5,,,1638,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1039.29,,,1638,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1932,,,1932,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1029,,,1070.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1785,,,1785,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1995,,,1890,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1890,,,1995,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1029,,,1029,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1638,2016,
HC PLATE CURVED 4 HOLE IMPLANT,Sx00040-15011,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2114.4,1902.96,2008.68,,,1902.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1649.23,,,1649.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1902.96,,,1760.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1902.96,,,1077.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1902.96,,,1760.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1036.06,,,1077.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1902.96,,,1902.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2029.82,,,2029.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1554.08,,,1649.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1046.42,,,1649.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1945.25,,,1945.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1036.06,,,1077.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1797.24,,,1797.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2008.68,,,1902.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1902.96,,,2008.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1036.06,,,1036.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1649.23,2029.82,
HC R&B HOSPICE ACUTE,Px00065610001,CDM,,,656,RC,,,,INPATIENT,,,2124,1911.6,2017.8,,,1911.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1656.72,,,1656.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1911.6,,,1768.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1911.6,,,1082.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1911.6,,,1768.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.76,,,1082.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1911.6,,,1911.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2039.04,,,2039.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1561.14,,,1656.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1040.76,,,1656.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1954.08,,,1954.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.76,,,1082.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1805.4,,,1805.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.8,,,1911.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1911.6,,,2017.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1040.76,,,1040.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1656.72,2039.04,
HC PROXIMAL TENODESIS IMPLANT SYSTEM REV,Sx0000AR-2290,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2126.25,1913.63,2019.94,,,1913.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1658.48,,,1658.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1913.63,,,1769.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1913.63,,,1083.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1913.63,,,1769.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1041.86,,,1083.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1913.63,,,1913.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2041.2,,,2041.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1562.79,,,1658.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1052.28,,,1658.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1956.15,,,1956.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1041.86,,,1083.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1807.31,,,1807.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2019.94,,,1913.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1913.63,,,2019.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1041.86,,,1041.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1658.48,2041.2,
HC SCREW ASNIS III SS CANNULATED 8X80MM,Sx00000326680,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2139,1925.1,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1668.42,,,1668.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1090.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2053.44,,,2053.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1572.17,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1058.59,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1967.88,,,1967.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1818.15,,,1818.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,2032.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1048.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1668.42,2053.44,
HC SCREW ASNIS III SS CANNULATED 8X85MM,Sx00000326685,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2139,1925.1,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1668.42,,,1668.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1090.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2053.44,,,2053.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1572.17,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1058.59,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1967.88,,,1967.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1818.15,,,1818.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,2032.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1048.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1668.42,2053.44,
HC SCREW ASNIS III SS CANNULATED 8X90MM,Sx00000326690,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2139,1925.1,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1668.42,,,1668.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1090.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1780.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2053.44,,,2053.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1572.17,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1058.59,,,1668.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1967.88,,,1967.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1090.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1818.15,,,1818.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.05,,,1925.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1925.1,,,2032.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1048.11,,,1048.11,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1668.42,2053.44,
HC T-PLATE OBLIQUE 2.7MM LEFT IMPLANT,Sx00040-15071,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2152.8,1937.52,2045.16,,,1937.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.18,,,1679.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1937.52,,,1791.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1937.52,,,1097.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1937.52,,,1791.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1054.87,,,1097.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1937.52,,,1937.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2066.69,,,2066.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1582.31,,,1679.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1065.42,,,1679.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1980.58,,,1980.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1054.87,,,1097.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1829.88,,,1829.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2045.16,,,1937.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1937.52,,,2045.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1054.87,,,1054.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1679.18,2066.69,
"HC PR 49020 DRAIN ABDOMINAL ABSCESS, OPEN",Px00097510846,CDM,49020,CPT,975,RC,,,,BOTH,,,3781,3402.9,2117.36,,,3402.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2156.75,,,2949.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2363.13,,,3147.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2363.13,,,1926.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2363.13,,,3147.31,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1769.94,,,1926.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1894.15,,,3402.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2079.55,,,3629.76,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.7,,,2949.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,225.7,,,2949.18,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2155.17,,,3478.52,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,1585.25,,,1926.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2155.17,,,3213.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2117.36,,,3402.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2076.3,,,3591.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,225.7,,,225.7,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,225.7,2076.3,
HC CTA ABDOMEN PELVIS,Px00035010072,CDM,74174,CPT,350,RC,,,,BOTH,,,2175,1957.5,2066.25,,,1957.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1696.5,,,1696.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1957.5,,,1810.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1957.5,,,1108.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1957.5,,,1810.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1065.75,,,1108.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1957.5,,,1957.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2088,,,2088,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1598.63,,,1696.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1076.41,,,1696.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2001,,,2001,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1065.75,,,1108.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1848.75,,,1848.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2066.25,,,1957.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1957.5,,,2066.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1065.75,,,1065.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1696.5,2088,
HC COMPRESSION FT SCREW 7.0 XL 50MM LENGTH,SxAR-8770-50H,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2189.25,1970.33,2079.79,,,1970.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1707.62,,,1707.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1970.33,,,1822.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1970.33,,,1115.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1970.33,,,1822.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1072.73,,,1115.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1970.33,,,1970.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2101.68,,,2101.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1609.1,,,1707.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1083.46,,,1707.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2014.11,,,2014.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1072.73,,,1115.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1860.86,,,1860.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2079.79,,,1970.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1970.33,,,2079.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1072.73,,,1072.73,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1707.62,2101.68,
HC PR 58563 HYSTEROSCOPY ABLATION,Px00097511106,CDM,58563,CPT,975,RC,,,,BOTH,,,590,531,330.4,,,531,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,285.3,,,460.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.75,,,484.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.75,,,275.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,368.75,,,484.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,272.72,,,275.6,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,293.34,,,531,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,324.5,,,473.1,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.15,,,460.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,237.15,,,460.2,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336.3,,,542.8,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,244.26,,,300.66,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,336.3,,,501.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,330.4,,,531,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2115.45,,,560.5,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,237.15,,,237.15,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,237.15,2115.45,
HC R&B NURSERY/LEVEL 1,Px00017110001,CDM,,,170,RC,,,,INPATIENT,,,2275,1422,2161.25,,,2161.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1774.5,,,1774.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2047.5,,,2047.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2047.5,,,2047.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2047.5,,,2047.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2047.5,,,2047.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2184,,,2184,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2093,,,2093,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1933.75,,,1933.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2161.25,,,2161.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2047.5,,,2047.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,1774.5,2184,
HC MESH PHYSIO SQUARE 15X15CM,Sx000PHY1515Q,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,2277.48,2049.73,2163.61,,,2049.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1776.43,,,1776.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2049.73,,,1895.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2049.73,,,1160.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2049.73,,,1895.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1115.97,,,1160.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2049.73,,,2049.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2186.38,,,2186.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1673.95,,,1776.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1127.12,,,1776.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2095.28,,,2095.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1115.97,,,1160.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1935.86,,,1935.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2163.61,,,2049.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2049.73,,,2163.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1115.97,,,1115.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1776.43,2186.38,
HC SECONDARY FIXATION BIOSWVLK 4.75X19.1,Sx0AR-1593-BC,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2283.75,2055.38,2169.56,,,2055.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1781.33,,,1781.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2055.38,,,1901,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2055.38,,,1163.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2055.38,,,1901,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1119.04,,,1163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2055.38,,,2055.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2192.4,,,2192.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1678.56,,,1781.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1130.23,,,1781.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2101.05,,,2101.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1119.04,,,1163.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1941.19,,,1941.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2169.56,,,2055.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2055.38,,,2169.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1119.04,,,1119.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1781.33,2192.4,
HC OPERATING ROOM SERVICES LEVEL 6,Px00036010026,CDM,,,360,RC,,,,BOTH,,,2287,2058.3,2172.65,,,2058.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1783.86,,,1783.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2058.3,,,1903.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2058.3,,,1165.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2058.3,,,1903.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.63,,,1165.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2058.3,,,2058.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2195.52,,,2195.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1680.95,,,1783.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1131.84,,,1783.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2104.04,,,2104.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.63,,,1165.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1943.95,,,1943.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2172.65,,,2058.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2058.3,,,2172.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1120.63,,,1120.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1783.86,2195.52,
HC PLATE LATERAL FIBULA 7-HOLE STERILE IMPLANT,Sx00040-20907,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2292,2062.8,2177.4,,,2062.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1787.76,,,1787.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2062.8,,,1907.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2062.8,,,1168,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2062.8,,,1907.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1123.08,,,1168,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2062.8,,,2062.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2200.32,,,2200.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1684.62,,,1787.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1134.31,,,1787.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2108.64,,,2108.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1123.08,,,1168,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1948.2,,,1948.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2177.4,,,2062.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2062.8,,,2177.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1123.08,,,1123.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1787.76,2200.32,
HC PLATE CURVED 5-HOLE RIGHT IMPL,Sx00040-15012,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2299.2,2069.28,2184.24,,,2069.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1793.38,,,1793.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2069.28,,,1913.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2069.28,,,1171.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2069.28,,,1913.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1126.61,,,1171.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2069.28,,,2069.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2207.23,,,2207.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1689.91,,,1793.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1137.87,,,1793.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2115.26,,,2115.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1126.61,,,1171.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1954.32,,,1954.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2184.24,,,2069.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2069.28,,,2184.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1126.61,,,1126.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1793.38,2207.23,
IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/100ML,Rx61953000502,CDM,J1572,HCPCS,636,RC,61953000502,NDC,,BOTH,100,ML,2340.21,2106.19,2223.2,,,2223.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1825.36,,,1825.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2106.19,,,2106.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2106.19,,,2106.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2106.19,,,2106.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1146.7,,,1146.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106.19,,,2106.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2246.6,,,2246.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1720.05,,,1720.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1146.7,,,1146.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2152.99,,,2152.99,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1146.7,,,1146.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1989.18,,,1989.18,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2223.2,,,2223.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2106.19,,,2106.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1146.7,,,1146.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1825.36,2246.6,
HC ED CRITICAL CARE FIRST HOUR CDM,Px00045010094,CDM,99291,CPT,450,RC,,,,OUTPATIENT,,,2343,1666.8,2225.85,,,1833.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1827.54,,,1588.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1695.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1038.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1695.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1038.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1833.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2249.28,,,297.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1722.11,,,1588.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.55,,,1588.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2155.56,,,1874.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1038.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1991.55,,,1731.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2225.85,,,1833.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1935.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1148.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1827.54,2249.28,
HC VARIAX COMPRESSION PLATE 7 HOLE/L90MM WITH LOCKING,Sx0000629527S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2343,2108.7,2225.85,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1827.54,,,1827.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1950.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1193.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1950.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1193.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2249.28,,,2249.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1722.11,,,1827.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.55,,,1827.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2155.56,,,2155.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1193.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1991.55,,,1991.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2225.85,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,2225.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1148.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1827.54,2249.28,
HC ED TRAUMA ACTIVATION FULL WITH CRITICAL CARE G0390 CDM,Px00068310001,CDM,G0390,CPT,450,RC,,,,OUTPATIENT,,,2343,2108.7,2225.85,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1827.54,,,1827.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1950.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1193.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,1950.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1193.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2249.28,,,2249.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1722.11,,,1827.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1159.55,,,1827.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2155.56,,,2155.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1193.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1991.55,,,1991.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2225.85,,,2108.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2108.7,,,2225.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1148.07,,,1148.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1827.54,2249.28,
HC MRI CERVICAL SPINE W/O DYE,Px00061210001,CDM,72141,CPT,610,RC,,,,BOTH,,,2361,2124.9,2242.95,,,2124.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1841.58,,,1841.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2124.9,,,1965.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2124.9,,,1203.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2124.9,,,1965.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1156.89,,,1203.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2124.9,,,2124.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2266.56,,,2266.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1735.34,,,1841.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1156.89,,,1841.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2172.12,,,2172.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1156.89,,,1203.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2006.85,,,2006.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2242.95,,,2124.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2124.9,,,2242.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1156.89,,,1156.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1841.58,2266.56,
HC MRI LUMBAR SPINE W/O DYE,Px00061210009,CDM,72148,CPT,610,RC,,,,BOTH,,,2363,2126.7,2244.85,,,2126.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1843.14,,,1843.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2126.7,,,1966.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2126.7,,,1204.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2126.7,,,1966.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.87,,,1204.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2126.7,,,2126.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268.48,,,2268.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1736.81,,,1843.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1157.87,,,1843.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2173.96,,,2173.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.87,,,1204.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2008.55,,,2008.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2244.85,,,2126.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2126.7,,,2244.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1157.87,,,1157.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1843.14,2268.48,
HC MRI THORACIC SPINE W/O DYE,Px00061210005,CDM,72146,CPT,610,RC,,,,BOTH,,,2365,2128.5,2246.75,,,2128.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1844.7,,,1844.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2128.5,,,1968.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2128.5,,,1205.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2128.5,,,1968.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.85,,,1205.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2128.5,,,2128.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2270.4,,,2270.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1738.28,,,1844.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1158.85,,,1844.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2175.8,,,2175.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.85,,,1205.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2010.25,,,2010.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2246.75,,,2128.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2128.5,,,2246.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1158.85,,,1158.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1844.7,2270.4,
HC MRI ABDOMEN WO CONTRAST,Px00061010083,CDM,74181,CPT,610,RC,,,,BOTH,,,2383,2144.7,2263.85,,,2144.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1858.74,,,1858.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2144.7,,,1983.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2144.7,,,1214.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2144.7,,,1983.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.67,,,1214.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2144.7,,,2144.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.68,,,2287.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1751.51,,,1858.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1167.67,,,1858.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2192.36,,,2192.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.67,,,1214.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2025.55,,,2025.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2263.85,,,2144.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2144.7,,,2263.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1167.67,,,1167.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1858.74,2287.68,
HC VOLAR DISTAL RAD PLATE TI STD RT 3 HOLE,SxAR-8916VSR-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2385,2146.5,2265.75,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1860.3,,,1860.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1985.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1215.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1985.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1215.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2289.6,,,2289.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1752.98,,,1860.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1180.34,,,1860.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2194.2,,,2194.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1215.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2027.25,,,2027.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2265.75,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,2265.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1168.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1860.3,2289.6,
HC VOLAR DISTAL RAD PLATE TI STD LT 3 HOLE,SxAR-8916VSL-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2385,2146.5,2265.75,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1860.3,,,1860.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1985.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1215.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,1985.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1215.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2289.6,,,2289.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1752.98,,,1860.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1180.34,,,1860.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2194.2,,,2194.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1215.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2027.25,,,2027.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2265.75,,,2146.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2146.5,,,2265.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1168.65,,,1168.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1860.3,2289.6,
HC ED MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES CDM,Px00045010631,CDM,64421,CPT,450,RC,,,,OUTPATIENT,,,2398,1705.5,2278.1,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1870.44,,,1626.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2158.2,,,1735.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2158.2,,,1062.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2158.2,,,1735.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1175.02,,,1062.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2158.2,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2302.08,,,2001.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1762.53,,,1626.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1186.77,,,1626.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2206.16,,,1918.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1175.02,,,1062.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2038.3,,,1772.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2278.1,,,1876.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2158.2,,,1980.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1175.02,,,1175.02,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1870.44,2302.08,
HC MRI PELVIS WO CONTRAST,Px00061010029,CDM,72195,CPT,610,RC,,,,BOTH,,,2400,2160,2280,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1872,,,1872,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1997.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1223.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1997.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1223.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2304,,,2304,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1872,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1872,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2208,,,2208,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1223.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2040,,,2040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2280,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,2280,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1176,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1872,2304,
HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST,Px00061010059,CDM,73220,CPT,610,RC,,,,BOTH,,,2400,2160,2280,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1872,,,1872,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1997.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1223.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,1997.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1223.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2304,,,2304,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1872,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1872,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2208,,,2208,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1223.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2040,,,2040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2280,,,2160,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2160,,,2280,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1176,,,1176,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1872,2304,
HC BREATHING RESPONSE TO HYPOXIA,Px00046010001,CDM,94450,CPT,460,RC,,,,BOTH,,,2413,568.8,2292.35,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.14,,,492.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,322.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2316.48,,,606.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.56,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,492.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2219.96,,,581.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,322.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2051.05,,,537.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2292.35,,,568.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,600.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,1182.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1882.14,2316.48,
HC ED ABD PARACENTESIS W/O IMAG GUID CDM,Px00045014046,CDM,49082,CPT,450,RC,,,,OUTPATIENT,,,2413,1716.3,2292.35,,,1888.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1882.14,,,1636.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,1746.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,1069.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,1746.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,1069.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,1888.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2316.48,,,100.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1773.56,,,1636.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1194.19,,,1636.44,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2219.96,,,1930.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,1069.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2051.05,,,1783.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2292.35,,,1888.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2171.7,,,1993.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1182.37,,,1182.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1882.14,2316.48,
HC MRI Implantable Port Powerport Isp 8 Fr. Single Lumen,Sx00001808000,CDM,C1788,HCPCS,278,RC,,,,BOTH,,,2421.6,2179.44,2300.52,,,2179.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1888.85,,,1888.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2179.44,,,2015.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2179.44,,,1234.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2179.44,,,2015.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1186.58,,,1234.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2179.44,,,2179.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2324.74,,,2324.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1779.88,,,1888.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1198.45,,,1888.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2227.87,,,2227.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1186.58,,,1234.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2058.36,,,2058.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2300.52,,,2179.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2179.44,,,2300.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1186.58,,,1186.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1888.85,2324.74,
DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),Rx57970010001,CDM,J0875,HCPCS,636,RC,57970010001,NDC,,BOTH,500,ME,2428.99,2187.76,2307.54,,,2186.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1894.61,,,1895.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2186.09,,,2022.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2186.09,,,1238.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2186.09,,,2022.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.21,,,1238.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2186.09,,,2186.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2331.83,,,2332.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1785.31,,,1895.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1190.21,,,1895.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2234.67,,,2235.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.21,,,1238.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2064.64,,,2065.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2307.54,,,2186.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2186.09,,,2308.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1190.21,,,1190.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1894.61,2331.83,
HC LOCK DISTAL FIBULA PLATE TI LEFT 4 HOLE,SxAR-9943BL-0,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2441.25,1620,2319.19,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,917.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1728,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1656,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1710,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC LOCK DISTAL FIBULA PLATE STAINLESS LEFT 5 HOLE,SxAR-9943BL-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2441.25,1890,2319.19,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1404,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,917.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1498.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1728,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1404,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1656,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,917.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1620,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1710,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC LOCKING DISTAL FIBULA TI RIGHT 6 HOLE,SxAR-9943BR-0,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2441.25,2197.13,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1474.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,963.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1814.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1738.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1606.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1795.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC LOCK DISTAL FIBULA PLATE TI RIGHT 5 HOLE,SxAR-9943BR-0,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2441.25,1984.5,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1474.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,963.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1814.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1738.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1606.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1795.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC LOCK DISTAL FIBULA PLATE STAINLESS RIGHT 8 HOLE,SxAR-9943BR-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2441.25,2281.5,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1474.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,963.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1814.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1738.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1606.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1795.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC LOCK DISTAL FIBULA PLATE TI RIGHT 4 HOLE,SxAR-9943BR-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2441.25,1701,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1904.18,,,1474.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,963.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1573.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2343.6,,,1814.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1794.32,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1208.17,,,1474.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2245.95,,,1738.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2075.06,,,1606.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2319.19,,,1701,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.13,,,1795.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1196.21,,,1196.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1904.18,2343.6,
HC ED REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ CDM,Px00045010860,CDM,49451,CPT,450,RC,,,,OUTPATIENT,,,2446,1740.6,2323.7,,,1914.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1907.88,,,1659.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2201.4,,,1770.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2201.4,,,1083.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2201.4,,,1770.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.54,,,1083.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2201.4,,,1914.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2348.16,,,2041.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1797.81,,,1659.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1210.53,,,1659.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2250.32,,,1956.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.54,,,1083.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2079.1,,,1807.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2323.7,,,1914.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2201.4,,,2020.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1198.54,,,1198.54,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1907.88,2348.16,
FERRIC CARBOXYMALTOSE IV SOLN 750 MG/15ML (FE EQUIVALENT),Rx00517065001,CDM,J1439,HCPCS,636,RC,517065001,NDC,,BOTH,15,ML,2479.92,2189.82,2355.92,,,2232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1934.34,,,1934.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2231.93,,,2064.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2231.93,,,1264.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2231.93,,,2064.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1215.16,,,1264.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2231.93,,,2232.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2380.72,,,2381.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1822.74,,,1934.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1215.16,,,1934.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2281.53,,,2282.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1215.16,,,1264.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2107.93,,,2108.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2355.92,,,2232.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2231.93,,,2356.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1215.16,,,1215.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1934.34,2380.72,
HC IMPLANT SYSTEM FIBERTAK BUTTON,Sx0000AR-3680,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2485.35,2236.82,2361.08,,,2236.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1938.57,,,1938.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2236.82,,,2068.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2236.82,,,1266.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2236.82,,,2068.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1217.82,,,1266.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2236.82,,,2236.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2385.94,,,2385.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1826.73,,,1938.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1230,,,1938.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2286.52,,,2286.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1217.82,,,1266.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2112.55,,,2112.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2361.08,,,2236.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2236.82,,,2361.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1217.82,,,1217.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1938.57,2385.94,
HC MRI LOWER EXTREMITY JOINT W CONTRAST,Px00061010077,CDM,73722,CPT,610,RC,,,,BOTH,,,2488,2239.2,2363.6,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1940.64,,,1940.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2071.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,1267.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2071.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1267.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2388.48,,,2388.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1828.68,,,1940.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1940.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2288.96,,,2288.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1267.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2114.8,,,2114.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2363.6,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2363.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1219.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1940.64,2388.48,
HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL,Px00061010282,CDM,77049,CPT,610,RC,,,,BOTH,,,2488,2239.2,2363.6,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1940.64,,,1940.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2071.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,1267.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2071.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1267.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2388.48,,,2388.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1828.68,,,1940.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1940.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2288.96,,,2288.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1267.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2114.8,,,2114.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2363.6,,,2239.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.2,,,2363.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.12,,,1219.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1940.64,2388.48,
IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/100ML,Rx44206043791,CDM,J1459,HCPCS,636,RC,44206043791,NDC,,BOTH,100,ML,2488.35,2239.52,2363.93,,,2363.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1940.91,,,1940.91,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2239.52,,,2239.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2239.52,,,2239.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2239.52,,,2239.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1219.29,,,1219.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2239.52,,,2239.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2388.82,,,2388.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1828.94,,,1828.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1219.29,,,1219.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2289.28,,,2289.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1219.29,,,1219.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2115.1,,,2115.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2363.93,,,2363.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2239.52,,,2239.52,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1219.29,,,1219.29,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1940.91,2388.82,
HC PLATE LATERAL FIBULA 4-HOLE DISTAL,Sx00040-20904,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2488.8,2239.92,2364.36,,,2239.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1941.26,,,1941.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.92,,,2071.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.92,,,1268.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.92,,,2071.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.51,,,1268.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2239.92,,,2239.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2389.25,,,2389.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1829.27,,,1941.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1231.71,,,1941.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2289.7,,,2289.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.51,,,1268.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2115.48,,,2115.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2364.36,,,2239.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2239.92,,,2364.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1219.51,,,1219.51,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1941.26,2389.25,
HC 32MM DIA COCR MOD HD 6MM NK,Sx00000163667,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2490,2241,2365.5,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1942.2,,,1942.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2072.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,1268.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2072.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1268.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2390.4,,,2390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1830.15,,,1942.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1232.3,,,1942.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2290.8,,,2290.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1268.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2116.5,,,2116.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2365.5,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2365.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1220.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1942.2,2390.4,
HC 28MM DIA COCR MOD HD 6MM NK,Sx00000163660,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2490,2241,2365.5,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1942.2,,,1942.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2072.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,1268.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2072.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1268.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2390.4,,,2390.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1830.15,,,1942.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1232.3,,,1942.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2290.8,,,2290.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1268.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2116.5,,,2116.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2365.5,,,2241,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2241,,,2365.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1220.1,,,1220.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1942.2,2390.4,
HC VOLAR DISTAL RAD PLATE TI NARROW RT 3 HOLE,SxAR-8916VNR-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2504.25,2253.83,2379.04,,,2253.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1953.32,,,1953.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2253.83,,,2084.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2253.83,,,1276.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2253.83,,,2084.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1227.08,,,1276.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2253.83,,,2253.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2404.08,,,2404.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1840.62,,,1953.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1239.35,,,1953.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2303.91,,,2303.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1227.08,,,1276.17,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2128.61,,,2128.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2379.04,,,2253.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2253.83,,,2379.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1227.08,,,1227.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1953.32,2404.08,
HC CTA AORTA BIL ILIOFEM W & WO CONTRAST,Px00035010031,CDM,75635,CPT,350,RC,,,,BOTH,,,2514,2262.6,2388.3,,,2262.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1960.92,,,1960.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2262.6,,,2092.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2262.6,,,1281.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2262.6,,,2092.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1231.86,,,1281.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2262.6,,,2262.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2413.44,,,2413.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1847.79,,,1960.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1244.18,,,1960.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2312.88,,,2312.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1231.86,,,1281.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2136.9,,,2136.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2388.3,,,2262.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2262.6,,,2388.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1231.86,,,1231.86,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1960.92,2413.44,
HC LOW PROFILE T-PLATE 3.0MM 3 HOLE TI,SxAR-8952TT-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2520,2268,2394,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1965.6,,,1965.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2097.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,1284.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2097.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1284.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2419.2,,,2419.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1852.2,,,1965.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1247.15,,,1965.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2318.4,,,2318.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1284.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2142,,,2142,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2394,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1234.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1965.6,2419.2,
HC X-PLATE MEDIUM 3.0MM TI,Sx00AR-8952XM,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2520,2268,2394,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1965.6,,,1965.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2097.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,1284.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2097.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1284.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2419.2,,,2419.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1852.2,,,1965.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1247.15,,,1965.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2318.4,,,2318.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1284.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2142,,,2142,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2268,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268,,,2394,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1234.8,,,1234.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1965.6,2419.2,
HC FIXATION DEVICE HERNIA REPAIR DISPOSABLE,Sx00ABSTACK30,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2536.92,2283.23,2410.07,,,2283.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1978.8,,,1978.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2283.23,,,2111.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2283.23,,,1292.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2283.23,,,2111.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1243.09,,,1292.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2283.23,,,2283.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2435.44,,,2435.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1864.64,,,1978.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1255.52,,,1978.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2333.97,,,2333.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1243.09,,,1292.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2156.38,,,2156.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2410.07,,,2283.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2283.23,,,2410.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1243.09,,,1243.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1978.8,2435.44,
HC CLAV FRAC PLT CENTRAL THIRD LFT SS SMALL CURVE,Sx00AR-2655CL,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2550,2295,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1989,,,1989,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,1299.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1874.25,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1262,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2167.5,,,2167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1249.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1989,2448,
HC BICEPS DISTAL IMPLT DEL SYSTM IMPLANT DELIVERY SYSTEM,Sx0000AR-2260,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2550,2295,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1989,,,1989,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,1299.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1874.25,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1262,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2167.5,,,2167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1249.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1989,2448,
HC TIGHTROPE KNOTLESS AC,Sx0000AR-2370,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2550,2295,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1989,,,1989,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,1299.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2122.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1874.25,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1262,,,1989,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1299.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2167.5,,,2167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2422.5,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1249.5,,,1249.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1989,2448,
HC VACUUM INDUCED HEMORRAGE CONTROL SYSTEM,Px00021217WNH,CDM,C2628,CPT,270,RC,,,,BOTH,,,2590,2331,2460.5,,,2331,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2020.2,,,2020.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2331,,,2155.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2331,,,1319.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2331,,,2155.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269.1,,,1319.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2331,,,2331,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2486.4,,,2486.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1903.65,,,2020.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1281.79,,,2020.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2382.8,,,2382.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269.1,,,1319.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2201.5,,,2201.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2460.5,,,2331,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2331,,,2460.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1269.1,,,1269.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2020.2,2486.4,
HC OPERATING ROOM SERVICES LEVEL 7,Px00036010027,CDM,,,360,RC,,,,BOTH,,,2603,2342.7,2472.85,,,2342.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2030.34,,,2030.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2342.7,,,2166.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2342.7,,,1326.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2342.7,,,2166.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1275.47,,,1326.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2342.7,,,2342.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2498.88,,,2498.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1913.21,,,2030.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1288.22,,,2030.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2394.76,,,2394.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1275.47,,,1326.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2212.55,,,2212.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2472.85,,,2342.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2342.7,,,2472.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1275.47,,,1275.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2030.34,2498.88,
HC KNOTLESS TIGHTROPE SYNDESMOSIS REPAIR IMPLANT SS,Sx00AR-8926SS,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2640,2376,2508,,,2376,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2059.2,,,2059.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2376,,,2197.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2376,,,1345.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2376,,,2197.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1293.6,,,1345.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2376,,,2376,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2534.4,,,2534.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1940.4,,,2059.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1306.54,,,2059.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2428.8,,,2428.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1293.6,,,1345.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2244,,,2244,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2508,,,2376,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2376,,,2508,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1293.6,,,1293.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2059.2,2534.4,
HC PORT INFUSION SGL 8FR POWERPORT MRI,Sx00001878000,CDM,,,270,RC,,,,BOTH,,,2643.63,2379.27,2511.45,,,2379.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2062.03,,,2062.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2379.27,,,2200.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2379.27,,,1347.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2379.27,,,2200.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1295.38,,,1347.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2379.27,,,2379.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.88,,,2537.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1943.07,,,2062.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1308.33,,,2062.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2432.14,,,2432.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1295.38,,,1347.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2247.09,,,2247.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511.45,,,2379.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2379.27,,,2511.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1295.38,,,1295.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2062.03,2537.88,
HC MRI THORACIC SPINE W/DYE,Px00061210007,CDM,72147,CPT,610,RC,,,,BOTH,,,2649,2384.1,2516.55,,,2384.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2066.22,,,2066.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2384.1,,,2205.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2384.1,,,1349.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2384.1,,,2205.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1298.01,,,1349.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2384.1,,,2384.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.04,,,2543.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1947.02,,,2066.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1298.01,,,2066.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2437.08,,,2437.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1298.01,,,1349.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2251.65,,,2251.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2516.55,,,2384.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2384.1,,,2516.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1298.01,,,1298.01,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2066.22,2543.04,
HC MRI ORBIT/FACE/NECK W/O DYE,Px00061010142,CDM,70540,CPT,610,RC,,,,BOTH,,,2660,2394,2527,,,2394,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2074.8,,,2074.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2214.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,1355.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2214.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1303.4,,,1355.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2394,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2553.6,,,2553.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1955.1,,,2074.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1303.4,,,2074.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2447.2,,,2447.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1303.4,,,1355.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2261,,,2261,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2527,,,2394,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394,,,2527,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1303.4,,,1303.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2074.8,2553.6,
HC CLAV FRAC PLT CENTRAL THIRD LFT SS X-SMALL CURVE,Sx00AR-2654CL,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2677.5,2409.75,2543.63,,,2409.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2088.45,,,2088.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2228.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,1364.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2228.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1364.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2409.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.4,,,2570.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1967.96,,,2088.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1325.09,,,2088.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2463.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1364.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2275.88,,,2275.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.63,,,2409.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2543.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1311.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2088.45,2570.4,
HC CLAV FRAC PLT CENTRAL THIRD RT SS SMALL CURVE,Sx00AR-2652CR,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2677.5,2409.75,2543.63,,,2409.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2088.45,,,2088.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2228.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,1364.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2228.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1364.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2409.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.4,,,2570.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1967.96,,,2088.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1325.09,,,2088.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2463.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1364.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2275.88,,,2275.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.63,,,2409.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2409.75,,,2543.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1311.98,,,1311.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2088.45,2570.4,
HC MRA NECK WO CONTRAST,Px00061010013,CDM,70547,CPT,610,RC,,,,BOTH,,,2678,2410.2,2544.1,,,2410.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2088.84,,,2088.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2410.2,,,2229.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2410.2,,,1364.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2410.2,,,2229.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1312.22,,,1364.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2410.2,,,2410.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.88,,,2570.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1968.33,,,2088.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1312.22,,,2088.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2463.76,,,2463.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1312.22,,,1364.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2276.3,,,2276.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2544.1,,,2410.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2410.2,,,2544.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1312.22,,,1312.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2088.84,2570.88,
HC CMC MINI T-ROPE 1.1MM,Sx00AR-8919DS,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2685,2416.5,2550.75,,,2416.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2094.3,,,2094.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.5,,,2235,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.5,,,1368.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.5,,,2235,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1315.65,,,1368.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2416.5,,,2416.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2577.6,,,2577.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1973.48,,,2094.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1328.81,,,2094.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2470.2,,,2470.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1315.65,,,1368.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2282.25,,,2282.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2550.75,,,2416.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.5,,,2550.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1315.65,,,1315.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2094.3,2577.6,
HC INSERTION PICC W/O IMG GDN 5 YR/>,Px00026010001,CDM,36569,CPT,260,RC,,,,BOTH,,,2697,2427.3,2562.15,,,2427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2103.66,,,2103.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2427.3,,,2244.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2427.3,,,1374.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2427.3,,,2244.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1321.53,,,1374.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2427.3,,,2427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2589.12,,,2589.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1982.3,,,2103.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1334.75,,,2103.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2481.24,,,2481.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1321.53,,,1374.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2292.45,,,2292.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2562.15,,,2427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2427.3,,,2562.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1321.53,,,1321.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2103.66,2589.12,
HC ALL POLY PATELLA CEMENTED 26MM DIA 8MM THICKNESS,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC ALL POLY PATELLA CEMENTED 32MM DIA 8.5MM THICKNESS,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC ALL POLY PATELLA CEMENTED 35MM DIA 9.0MM THICKNESS,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC ALL POLY PATELLA CEMENTED 38MM DIA 9.5MM THICKNESS,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC ALL POLY PATELLA CEMENTED 29MM DIA 8MM THICKNESS,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC PSN ALL POLY PAT PLY 41MM,Sx42-5400-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2700,2430,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2106,,,2106,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,1375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2247.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2592,,,2592,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1336.23,,,2106,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2295,,,2295,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2430,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1323,,,1323,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2106,2592,
HC MRI CHEST WO CONTRAST,Px00061010019,CDM,71550,CPT,610,RC,,,,BOTH,,,2709,2438.1,2573.55,,,2438.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2113.02,,,2113.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2438.1,,,2254.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2438.1,,,1380.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2438.1,,,2254.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1327.41,,,1380.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2438.1,,,2438.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2600.64,,,2600.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1991.12,,,2113.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1327.41,,,2113.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2492.28,,,2492.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1327.41,,,1380.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2302.65,,,2302.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2573.55,,,2438.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2438.1,,,2573.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1327.41,,,1327.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2113.02,2600.64,
HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST,Px00061010065,CDM,73718,CPT,610,RC,,,,BOTH,,,2720,2448,2584,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2121.6,,,2121.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2264.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,1386.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2264.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.8,,,1386.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2611.2,,,2611.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1999.2,,,2121.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1332.8,,,2121.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2502.4,,,2502.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.8,,,1386.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2312,,,2312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2584,,,2448,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2448,,,2584,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1332.8,,,1332.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2121.6,2611.2,
HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST,Px00061010054,CDM,73218,CPT,610,RC,,,,BOTH,,,2737,2463.3,2600.15,,,2463.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2134.86,,,2134.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2278.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,1394.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2278.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1341.13,,,1394.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2463.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2627.52,,,2627.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2011.7,,,2134.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1341.13,,,2134.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2518.04,,,2518.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1341.13,,,1394.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2326.45,,,2326.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2600.15,,,2463.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2463.3,,,2600.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1341.13,,,1341.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2134.86,2627.52,
HC INTRA ACUITY PER HR CLASS 4,Px00072010077,CDM,,,720,RC,,,,BOTH,,,2740,1710,2603,,,2052,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2137.2,,,1778.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2466,,,1897.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2466,,,1161.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2466,,,1897.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1342.6,,,1161.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2466,,,2052,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2630.4,,,2188.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2013.9,,,1778.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1342.6,,,1778.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2520.8,,,2097.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1342.6,,,1161.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2329,,,1938,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2603,,,2052,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2466,,,2166,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1342.6,,,1342.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2137.2,2630.4,
HC 36MM COCR MOD HD -3MM,Sx0011-363661,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2760,2484,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2152.8,,,2152.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,1406.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2649.6,,,2649.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2028.6,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1365.92,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2539.2,,,2539.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2152.8,2649.6,
HC 36MM COCR MOD HD 6MM,Sx0011-363660,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2760,2484,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2152.8,,,2152.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,1406.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2649.6,,,2649.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2028.6,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1365.92,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2539.2,,,2539.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2152.8,2649.6,
HC 36MM COCR MOD HD +3MM,Sx0011-363663,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2760,2484,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2152.8,,,2152.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,1406.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2649.6,,,2649.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2028.6,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1365.92,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2539.2,,,2539.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2152.8,2649.6,
HC 36MM COCR MOD HD +6MM,Sx0011-363664,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2760,2484,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2152.8,,,2152.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,1406.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2297.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2649.6,,,2649.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2028.6,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1365.92,,,2152.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2539.2,,,2539.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1406.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2346,,,2346,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622,,,2484,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2484,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1352.4,,,1352.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2152.8,2649.6,
HC MRI BRAIN W/O DYE,Px00061110001,CDM,70551,CPT,610,RC,,,,BOTH,,,2790,2511,2650.5,,,2511,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2176.2,,,2176.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511,,,2322.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511,,,1421.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511,,,2322.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.1,,,1421.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2511,,,2511,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.4,,,2678.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2050.65,,,2176.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1367.1,,,2176.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2566.8,,,2566.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.1,,,1421.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2371.5,,,2371.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2650.5,,,2511,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511,,,2650.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.1,,,1367.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2176.2,2678.4,
CALCITONIN (SALMON) INJ 200 UNIT/ML,Rx72078003902,CDM,J0630,HCPCS,636,RC,72078003902,NDC,,BOTH,1,ML,2790.6,2511.54,2651.07,,,2511.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2176.67,,,2176.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511.54,,,2322.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511.54,,,1422.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511.54,,,2322.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.39,,,1422.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2511.54,,,2511.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.98,,,2678.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2051.09,,,2176.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1367.39,,,2176.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2567.35,,,2567.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.39,,,1422.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2372.01,,,2372.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2651.07,,,2511.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2511.54,,,2651.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1367.39,,,1367.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2176.67,2678.98,
HC NEEDLE BIOPSY LYMPH NODES,Px00036110934,CDM,38505,CPT,361,RC,,,,BOTH,,,2794,2514.6,2654.3,,,2514.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2179.32,,,2179.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2514.6,,,2325.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2514.6,,,1423.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2514.6,,,2325.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1369.06,,,1423.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2514.6,,,2514.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2682.24,,,2682.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2053.59,,,2179.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1382.75,,,2179.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2570.48,,,2570.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1369.06,,,1423.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2374.9,,,2374.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2654.3,,,2514.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2514.6,,,2654.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1369.06,,,1369.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2179.32,2682.24,
HC LAG SCREW GALILEO RIGHT 10.5MMX100MM,Sx0001099-100,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2819.25,2537.33,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.02,,,2199.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,1436.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.48,,,2706.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2072.15,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1395.25,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2593.71,,,2593.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2396.36,,,2396.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2678.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1381.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2199.02,2706.48,
HC LAG SCREW GALILEO RIGHT 10.5MMX115MM,Sx0001099-115,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2819.25,2537.33,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.02,,,2199.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,1436.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.48,,,2706.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2072.15,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1395.25,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2593.71,,,2593.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2396.36,,,2396.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2678.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1381.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2199.02,2706.48,
HC LAG SCREW GALILEO RIGHT 10.5MMX95MM,Sx0001099-095,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2819.25,2537.33,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.02,,,2199.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,1436.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2346.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.48,,,2706.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2072.15,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1395.25,,,2199.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2593.71,,,2593.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1436.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2396.36,,,2396.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.29,,,2537.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2537.33,,,2678.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1381.43,,,1381.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2199.02,2706.48,
HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE,Px00098310432,CDM,59400,CPT,975,RC,,,,BOTH,,,5761,5184.9,3226.16,,,5184.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2641.98,,,4493.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3600.63,,,4795.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3600.63,,,2935.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3600.63,,,4795.46,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2683.03,,,2935.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2467.73,,,5184.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3168.55,,,5530.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,4493.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,4493.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3283.77,,,5300.12,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2403.06,,,2935.81,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3283.77,,,4896.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3226.16,,,5184.9,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2707.64,,,5472.95,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,141.27,,,141.27,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,141.27,2707.64,
IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/100ML,Rx44206043710,CDM,J1459,HCPCS,636,RC,44206043710,NDC,,BOTH,100,ML,2825.96,2399.79,2684.66,,,2543.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2204.25,,,2204.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.36,,,2352.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.36,,,1440.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.36,,,2352.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.72,,,1440.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2543.36,,,2543.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2712.92,,,2712.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2077.08,,,2204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1384.72,,,2204.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2599.88,,,2599.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.72,,,1440.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2402.07,,,2402.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2684.66,,,2543.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2543.36,,,2684.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1384.72,,,1384.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2204.25,2712.92,
HC R&B-SEMI-PRIVATE SWING BED,Px00012010004,CDM,,,120,RC,,,,INPATIENT,,,2827,2313,2685.65,,,2685.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2205.06,,,2205.06,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2544.3,,,2544.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2544.3,,,2544.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2544.3,,,2544.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3744,,,3744,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2544.3,,,2544.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2713.92,,,2713.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5878.08,,,5878.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3744,,,3744,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2600.84,,,2600.84,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3744,,,3744,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2402.95,,,2402.95,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2685.65,,,2685.65,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2544.3,,,2544.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3347.4,,,3970.51,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2205.06,2713.92,
INFLIXIMAB FOR IV INJ 100 MG,Rx57894003001,CDM,J1745,HCPCS,636,RC,57894003001,NDC,,BOTH,100,ME,2835.2,2553.64,2693.44,,,2693.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2211.46,,,2211.46,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2551.68,,,2551.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2551.68,,,2551.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2551.68,,,2551.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1389.25,,,1389.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2551.68,,,2551.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2721.79,,,2721.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2083.87,,,2083.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1389.25,,,1389.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2608.38,,,2608.38,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1389.25,,,1389.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2409.92,,,2409.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2693.44,,,2693.44,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2551.68,,,2551.68,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1389.25,,,1389.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2211.46,2721.79,
HC CENTRAL SCREW MODULAR 30MM,SxAR-9561-30S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2850,2565,2707.5,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2223,,,2223,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2372.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,1452.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2372.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1396.5,,,1452.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2736,,,2736,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2094.75,,,2223,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1410.47,,,2223,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2622,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1396.5,,,1452.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2422.5,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2707.5,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2565,,,2707.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1396.5,,,1396.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2223,2736,
HC R&B-SEMI-PRIVATE,Px00012010001,CDM,,,120,RC,,,,INPATIENT,,,2850,1935,2707.5,,,2707.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2223,,,2223,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2736,,,2736,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2622,,,2622,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2422.5,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2707.5,,,2707.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2565,,,2565,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2223,2736,
HC MRI THORACIC SPINE W/O & W/DYE,Px00061210015,CDM,72157,CPT,610,RC,,,,BOTH,,,2870,2583,2726.5,,,2583,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2238.6,,,2238.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2583,,,2388.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2583,,,1462.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2583,,,2388.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.3,,,1462.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2583,,,2583,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2755.2,,,2755.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2109.45,,,2238.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1406.3,,,2238.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2640.4,,,2640.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.3,,,1462.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2439.5,,,2439.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2726.5,,,2583,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2583,,,2726.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1406.3,,,1406.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2238.6,2755.2,
HC DRILL BONE GRAFT 8MM ACUMED,Sx00BG-8010-S,CDM,,,270,RC,,,,BOTH,,,2895,2303.1,2750.25,,,2521.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2258.1,,,2185.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2605.5,,,2332.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2605.5,,,1427.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2605.5,,,2332.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1418.55,,,1427.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2605.5,,,2521.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2779.2,,,2689.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2127.83,,,2185.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1432.74,,,2185.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2663.4,,,2577.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1418.55,,,1427.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2460.75,,,2381.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2750.25,,,2521.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2605.5,,,2661.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1418.55,,,1418.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2258.1,2779.2,
HC UNIVERSAL 5TH METATARSAL HOOK PLATE,Sx0AR-8956-01,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,2913.75,2622.38,2768.06,,,2622.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2272.73,,,2272.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622.38,,,2425.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622.38,,,1484.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622.38,,,2425.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1427.74,,,1484.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2622.38,,,2622.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2797.2,,,2797.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2141.61,,,2272.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1442.01,,,2272.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2680.65,,,2680.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1427.74,,,1484.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2476.69,,,2476.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2768.06,,,2622.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2622.38,,,2768.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1427.74,,,1427.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2272.73,2797.2,
HC HEADLESS COMPRESS SCR 7X70MM SHORT THREAD,Sx00000658370,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2925,2632.5,2778.75,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2281.5,,,2281.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2434.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,1490.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2434.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1490.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2808,,,2808,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2149.88,,,2281.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1447.58,,,2281.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2691,,,2691,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1490.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2486.25,,,2486.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2778.75,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2778.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1433.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2281.5,2808,
HC HEADLESS COMPRESS SCR 7X65MM LONG THREAD,Sx00000658565,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2925,2632.5,2778.75,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2281.5,,,2281.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2434.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,1490.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2434.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1490.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2808,,,2808,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2149.88,,,2281.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1447.58,,,2281.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2691,,,2691,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1490.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2486.25,,,2486.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2778.75,,,2632.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2632.5,,,2778.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1433.25,,,1433.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2281.5,2808,
MEPOLIZUMAB FOR INJ 100 MG,Rx00173088101,CDM,J2182,HCPCS,636,RC,173088101,NDC,,BOTH,100,ME,2980.45,2694.01,2831.43,,,2682.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2324.75,,,2324.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2682.41,,,2480.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2682.41,,,1518.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2682.41,,,2480.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.42,,,1518.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2682.41,,,2682.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2861.23,,,2861.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2190.63,,,2324.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1460.42,,,2324.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2742.01,,,2742.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.42,,,1518.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2533.38,,,2533.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2831.43,,,2682.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2682.41,,,2831.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1460.42,,,1460.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2324.75,2861.23,
HC MENISCAL ROOT KIT,Sx0000AR-4550,CDM,,,270,RC,,,,BOTH,,,2985,2686.5,2835.75,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2328.3,,,2328.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2484.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,1521.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2484.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1521.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2865.6,,,2865.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2193.98,,,2328.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1477.28,,,2328.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2746.2,,,2746.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1521.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2537.25,,,2537.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2835.75,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2835.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1462.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2328.3,2865.6,
HC VOLAR DISTAL RADIUS PLATE STD 3 HOLE RIGHT,SxGMN-RTS-3HL,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2985,2686.5,2835.75,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2328.3,,,2328.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2484.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,1521.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2484.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1521.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2865.6,,,2865.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2193.98,,,2328.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1477.28,,,2328.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2746.2,,,2746.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1521.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2537.25,,,2537.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2835.75,,,2686.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2686.5,,,2835.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1462.65,,,1462.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2328.3,2865.6,
HC CENTRAL SCREW MODULAR 20MM,SxAR-9561-20S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2992.5,2565,2842.88,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2334.15,,,2223,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2372.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,1452.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2372.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1452.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2872.8,,,2736,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.49,,,2223,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1480.99,,,2223,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2753.1,,,2622,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1452.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2543.63,,,2422.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2842.88,,,2565,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2707.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1466.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2334.15,2872.8,
HC CENTRAL SCREW MODULAR 25MM,SxAR-9561-25S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,2992.5,2693.25,2842.88,,,2693.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2334.15,,,2334.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2490.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,1524.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2490.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1524.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2693.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2872.8,,,2872.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.49,,,2334.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1480.99,,,2334.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2753.1,,,2753.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1524.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2543.63,,,2543.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2842.88,,,2693.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.25,,,2842.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.33,,,1466.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2334.15,2872.8,
HC OPERATING ROOM SERVICES LEVEL 8,Px00036010028,CDM,,,360,RC,,,,BOTH,,,2993,2693.7,2843.35,,,2693.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2334.54,,,2334.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.7,,,2491.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.7,,,1525.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.7,,,2491.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.57,,,1525.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2693.7,,,2693.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2873.28,,,2873.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2199.86,,,2334.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1481.24,,,2334.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2753.56,,,2753.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.57,,,1525.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2544.05,,,2544.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2843.35,,,2693.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2693.7,,,2843.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1466.57,,,1466.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2334.54,2873.28,
HC ALLOGRAFT DBM PUTTY 5CC,Sx003102-1005,CDM,C9359,HCPCS,278,RC,,,,BOTH,,,2994.81,2518.99,2845.07,,,2695.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2335.95,,,2335.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2695.33,,,2492.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2695.33,,,1526.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2695.33,,,2492.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1467.46,,,1526.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2695.33,,,2695.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2875.02,,,2875.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2201.19,,,2335.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1482.13,,,2335.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2755.23,,,2755.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1467.46,,,1526.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2545.59,,,2545.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2845.07,,,2695.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2695.33,,,2845.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1467.46,,,1467.46,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2335.95,2875.02,
HC HUMERAL INSERT M/39 +6,SxAR-9503M-06,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3045,2740.5,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2375.1,,,2375.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,1551.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2923.2,,,2923.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2238.08,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1506.97,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2801.4,,,2801.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2588.25,,,2588.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2892.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1492.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2375.1,2923.2,
HC HUMERAL INSERT L/42 +6 TO FIT IN 42 CUP,SxAR-9503L-06,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3045,2740.5,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2375.1,,,2375.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,1551.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2923.2,,,2923.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2238.08,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1506.97,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2801.4,,,2801.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2588.25,,,2588.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2892.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1492.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2375.1,2923.2,
HC COMBO HUMERAL INSERT 36+ 6/33 0,SxAR-9503-363,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3045,2740.5,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2375.1,,,2375.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,1551.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2923.2,,,2923.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2238.08,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1506.97,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2801.4,,,2801.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2588.25,,,2588.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2892.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1492.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2375.1,2923.2,
HC COMBO HUMERAL INSERT 36+ 3/33,SxAR-9503-363,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3045,2740.5,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2375.1,,,2375.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,1551.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2534.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2923.2,,,2923.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2238.08,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1506.97,,,2375.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2801.4,,,2801.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1551.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2588.25,,,2588.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2892.75,,,2740.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2740.5,,,2892.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1492.05,,,1492.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2375.1,2923.2,
HC MRA HEAD W CONTRAST,Px00061010010,CDM,70545,CPT,610,RC,,,,BOTH,,,3060,2754,2907,,,2754,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2386.8,,,2386.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2754,,,2547.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2754,,,1559.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2754,,,2547.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1499.4,,,1559.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2754,,,2754,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2937.6,,,2937.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2249.1,,,2386.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1499.4,,,2386.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2815.2,,,2815.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1499.4,,,1559.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2601,,,2601,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2907,,,2754,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2754,,,2907,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1499.4,,,1499.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2386.8,2937.6,
HC MRI LUMBAR SPINE W/DYE,Px00061210011,CDM,72149,CPT,610,RC,,,,BOTH,,,3069,2762.1,2915.55,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2393.82,,,2393.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2554.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,1563.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2554.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1563.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2946.24,,,2946.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2255.72,,,2393.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,2393.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2823.48,,,2823.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1563.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2608.65,,,2608.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2915.55,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2915.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1503.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2393.82,2946.24,
HC GRAFIX CORE 2X3 SKIN GRAFT    Q CODE Q4132,Sx0000PS12023,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3069,2762.1,2915.55,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2393.82,,,2393.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2554.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,1563.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2554.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1563.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2946.24,,,2946.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2255.72,,,2393.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1518.85,,,2393.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2823.48,,,2823.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1563.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2608.65,,,2608.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2915.55,,,2762.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2762.1,,,2915.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1503.81,,,1503.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2393.82,2946.24,
HC MRI BRAIN W/DYE,Px00061110007,CDM,70552,CPT,610,RC,,,,BOTH,,,3070,2763,2916.5,,,2763,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2394.6,,,2394.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2763,,,2555.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2763,,,1564.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2763,,,2555.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.3,,,1564.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2763,,,2763,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2947.2,,,2947.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2256.45,,,2394.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1504.3,,,2394.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2824.4,,,2824.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.3,,,1564.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2609.5,,,2609.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2916.5,,,2763,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2763,,,2916.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.3,,,1504.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2394.6,2947.2,
HC IMPLANT SYS BIOCOMP ACHILLES SPEEDB MID-SUBSTANCE,SxAR-8928BC-C,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3071.25,2764.13,2917.69,,,2764.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2395.58,,,2395.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2764.13,,,2556.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2764.13,,,1565.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2764.13,,,2556.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.91,,,1565.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2764.13,,,2764.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2948.4,,,2948.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2257.37,,,2395.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1519.96,,,2395.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2825.55,,,2825.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.91,,,1565.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2610.56,,,2610.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2917.69,,,2764.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2764.13,,,2917.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1504.91,,,1504.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2395.58,2948.4,
HC MRI CERVICAL SPINE W/DYE,Px00061210003,CDM,72142,CPT,610,RC,,,,BOTH,,,3086,2777.4,2931.7,,,2777.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2407.08,,,2407.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2777.4,,,2568.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2777.4,,,1572.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2777.4,,,2568.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.14,,,1572.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2777.4,,,2777.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2962.56,,,2962.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2268.21,,,2407.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1512.14,,,2407.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2839.12,,,2839.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.14,,,1572.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2623.1,,,2623.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2931.7,,,2777.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2777.4,,,2931.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1512.14,,,1512.14,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2407.08,2962.56,
HC NEX KIT 3.5 MID 3.2 PROX HAMMERTOE CORRECTION SYSTEM,Sx000NX-3532K,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3094.86,3969,2940.12,,,2785.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2413.99,,,2413.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.37,,,2576.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.37,,,1577.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.37,,,2576.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1516.48,,,1577.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2785.37,,,2785.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2971.07,,,2971.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2274.72,,,2413.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1531.65,,,2413.99,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2847.27,,,2847.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1516.48,,,1577.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2630.63,,,2630.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940.12,,,2785.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.37,,,2940.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1516.48,,,1516.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2413.99,2971.07,
HC MRI CERVICAL SPINE W/O & W/DYE,Px00061210013,CDM,72156,CPT,610,RC,,,,BOTH,,,3113,2801.7,2957.35,,,2801.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2428.14,,,2428.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2801.7,,,2591.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2801.7,,,1586.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2801.7,,,2591.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.37,,,1586.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2801.7,,,2801.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2988.48,,,2988.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2288.06,,,2428.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1525.37,,,2428.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2863.96,,,2863.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.37,,,1586.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2646.05,,,2646.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2957.35,,,2801.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2801.7,,,2957.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1525.37,,,1525.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2428.14,2988.48,
HC MRA HEAD WO CONTRAST,Px00061010009,CDM,70544,CPT,610,RC,,,,BOTH,,,3117,2805.3,2961.15,,,2805.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2431.26,,,2431.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2805.3,,,2594.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2805.3,,,1588.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2805.3,,,2594.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1527.33,,,1588.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2805.3,,,2805.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2992.32,,,2992.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2291,,,2431.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1527.33,,,2431.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2867.64,,,2867.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1527.33,,,1588.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2649.45,,,2649.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2961.15,,,2805.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2805.3,,,2961.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1527.33,,,1527.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2431.26,2992.32,
HC PR 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM,Px00097511315,CDM,59510,CPT,975,RC,,,,BOTH,,,6363,5726.7,3563.28,,,5726.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2905.1,,,4963.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3976.88,,,5296.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3976.88,,,3242.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3976.88,,,5296.56,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2970.52,,,3242.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2734.65,,,5726.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3499.65,,,6108.48,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,4963.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,4963.14,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3626.91,,,5853.96,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,2660.55,,,3242.58,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3626.91,,,5408.55,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3563.28,,,5726.7,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,3005.55,,,6044.85,fee schedule,One or more instances of the item or service in the 12 months prior to posting the file,170.28,,,170.28,fee schedule,Zero Instances of Item of service in the 12 months prior to posting the file,170.28,3005.55,
HC MESH PROCEED HERNIA 6X8 PCDG-1,Sx000000PCDG1,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,3134.88,2908.19,2978.14,,,2908.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2445.21,,,2520.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.39,,,2689.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.39,,,1646.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.39,,,2689.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.09,,,1646.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2821.39,,,2908.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3009.48,,,3102.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2304.14,,,2520.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1551.45,,,2520.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2884.09,,,2972.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.09,,,1646.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2664.65,,,2746.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2978.14,,,2908.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.39,,,3069.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.09,,,1536.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2445.21,3009.48,
HC VOLOR DISTAL RADIUS PLATE NARROW 3 HOLE LEFT,SxGMN-LTN-3HL,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3135,2821.5,2978.25,,,2821.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2445.3,,,2445.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.5,,,2609.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.5,,,1597.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.5,,,2609.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.15,,,1597.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2821.5,,,2821.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3009.6,,,3009.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2304.23,,,2445.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1551.51,,,2445.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2884.2,,,2884.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.15,,,1597.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2664.75,,,2664.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2978.25,,,2821.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2821.5,,,2978.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1536.15,,,1536.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2445.3,3009.6,
HC R&B NURSERY/LEVEL 2,Px00017210001,CDM,,,171,RC,,,,INPATIENT,,,3170,1980,3011.5,,,3011.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2472.6,,,2472.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2853,,,2853,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2853,,,2853,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2853,,,2853,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2853,,,2853,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3043.2,,,3043.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2916.4,,,2916.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2694.5,,,2694.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3011.5,,,3011.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2853,,,2853,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2472.6,3043.2,
ZOLEDRONIC ACID IV SOLN 5 MG/100ML,Rx00078043561,CDM,J3489,HCPCS,636,RC,78043561,NDC,,BOTH,100,ML,3179.73,2605.85,3020.74,,,3020.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2480.19,,,2480.19,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2861.76,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2861.76,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2861.76,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1558.07,,,1558.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2861.76,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3052.54,,,3052.54,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2337.1,,,2337.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1558.07,,,1558.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2925.35,,,2925.35,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1558.07,,,1558.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2702.77,,,2702.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3020.74,,,3020.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2861.76,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1558.07,,,1558.07,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2480.19,3052.54,
HC HUMERAL INSERT S/36 +3 TO FIT IN 36 CUP,SxAR-9503S-03,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3197.25,2877.53,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2493.86,,,2493.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,1629.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3069.36,,,3069.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2349.98,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1582.32,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2941.47,,,2941.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2717.66,,,2717.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,3037.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1566.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2493.86,3069.36,
HC HUMERAL INSERT M/39 +3 TO FIT IN 39 CUP,SxAR-9503M-03,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3197.25,2740.5,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2493.86,,,2493.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,1629.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3069.36,,,3069.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2349.98,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1582.32,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2941.47,,,2941.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2717.66,,,2717.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,3037.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1566.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2493.86,3069.36,
HC HUMERAL INSERT S/36 +6 TO FIT IN 36 CUP,SxAR-9503S-06,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3197.25,2740.5,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2493.86,,,2493.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,1629.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2661.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3069.36,,,3069.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2349.98,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1582.32,,,2493.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2941.47,,,2941.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1629.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2717.66,,,2717.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3037.39,,,2877.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2877.53,,,3037.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1566.65,,,1566.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2493.86,3069.36,
HC TCC-EZ CASTING SYSTEM LARGE 10 3 IN CASTING AND 2 LG BOOTS,Sx000TCC23214,CDM,,,270,RC,,,,BOTH,,,3201.3,2881.17,3041.24,,,2881.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2497.01,,,2497.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2881.17,,,2664.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2881.17,,,1631.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2881.17,,,2664.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1568.64,,,1631.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2881.17,,,2881.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3073.25,,,3073.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2352.96,,,2497.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1584.32,,,2497.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2945.2,,,2945.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1568.64,,,1631.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2721.11,,,2721.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3041.24,,,2881.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2881.17,,,3041.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1568.64,,,1568.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2497.01,3073.25,
HC MIRENA LEVONORGESTROL 52 MG SYS UD,Sx00000MIRENA,CDM,,,270,RC,,,,BOTH,,,3229.56,2944.86,3068.08,,,2906.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2519.06,,,2519.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2906.6,,,2688.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2906.6,,,1645.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2906.6,,,2688.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1582.48,,,1645.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2906.6,,,2906.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3100.38,,,3100.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2373.73,,,2519.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1598.31,,,2519.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2971.2,,,2971.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1582.48,,,1645.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2745.13,,,2745.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3068.08,,,2906.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2906.6,,,3068.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1582.48,,,1582.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2519.06,3100.38,
HC MEMOFIX NITINOL STAPLE 12MM X 10MM X 10MM NON IMPL,Sx000MS121010,CDM,,,270,RC,,,,BOTH,,,3283.14,2954.83,3118.98,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2560.85,,,2560.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2732.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,1673.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2732.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1673.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3151.81,,,3151.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2413.11,,,2560.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1624.83,,,2560.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3020.49,,,3020.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1673.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2790.67,,,2790.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3118.98,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,3118.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1608.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2560.85,3151.81,
HC MEMOFIX NITINOL STAPLE 12MM X 10MM X 10MM IMPLANT,Sx000MS121010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3283.14,2954.83,3118.98,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2560.85,,,2560.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2732.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,1673.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2732.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1673.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3151.81,,,3151.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2413.11,,,2560.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1624.83,,,2560.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3020.49,,,3020.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1673.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2790.67,,,2790.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3118.98,,,2954.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2954.83,,,3118.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1608.74,,,1608.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2560.85,3151.81,
HC INSERTION PICC W/RS&I 5 YR/> [36573] CDM,Px00076100033,CDM,36573,CPT,761,RC,,,,BOTH,,,3295,2965.5,3130.25,,,2965.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.1,,,2570.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2965.5,,,2742.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2965.5,,,1679.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2965.5,,,2742.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1614.55,,,1679.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2965.5,,,2965.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3163.2,,,3163.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2421.83,,,2570.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1614.55,,,2570.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3031.4,,,3031.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1614.55,,,1679.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2800.75,,,2800.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3130.25,,,2965.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2965.5,,,3130.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1614.55,,,1614.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2570.1,3163.2,
HC BX BREAST 1ST LESION US IMAG,Px00036111185,CDM,19083,CPT,361,RC,,,,BOTH,,,3297,2967.3,3132.15,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2571.66,,,2571.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2744.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,1680.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2744.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1680.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3165.12,,,3165.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2423.3,,,2571.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1631.69,,,2571.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3033.24,,,3033.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1680.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2802.45,,,2802.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3132.15,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,3132.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1615.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2571.66,3165.12,
HC NEEDLE BX MUSCLE,Px00036010123,CDM,20206,CPT,361,RC,,,,BOTH,,,3297,2967.3,3132.15,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2571.66,,,2571.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2744.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,1680.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2744.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1680.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3165.12,,,3165.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2423.3,,,2571.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1631.69,,,2571.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3033.24,,,3033.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1680.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2802.45,,,2802.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3132.15,,,2967.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.3,,,3132.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1615.53,,,1615.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2571.66,3165.12,
HC ULNAR OSTEOTOMY COMPRESSION PLATE,Sx0000000UOCP,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3300,2970,3135,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2574,,,2574,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2746.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,1681.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2746.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1681.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3168,,,3168,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2425.5,,,2574,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1633.17,,,2574,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3036,,,3036,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1681.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2805,,,2805,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3135,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,3135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1617,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2574,3168,
HC SEMI T GRAFT 4.5 X 240 ALLOGRAFT,Sx0000SST-001,CDM,C1762,HCPCS,278,RC,,,,BOTH,,,3300,2970,3135,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2574,,,2574,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2746.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,1681.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2746.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1681.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3168,,,3168,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2425.5,,,2574,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1633.17,,,2574,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3036,,,3036,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1681.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2805,,,2805,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3135,,,2970,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970,,,3135,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1617,,,1617,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2574,3168,
HC MRI PELVIS WO & W CONTRAST,Px00061010044,CDM,72197,CPT,610,RC,,,,BOTH,,,3307,2976.3,3141.65,,,2976.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2579.46,,,2579.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.3,,,2752.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.3,,,1685.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.3,,,2752.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620.43,,,1685.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2976.3,,,2976.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3174.72,,,3174.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2430.65,,,2579.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1620.43,,,2579.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3042.44,,,3042.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620.43,,,1685.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2810.95,,,2810.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3141.65,,,2976.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.3,,,3141.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1620.43,,,1620.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2579.46,3174.72,
HC R&B-SEMI-PRIVATE W/ IV OR TELE,Px00012010012,CDM,,,120,RC,,,,INPATIENT,,,3340,2250,3173,,,3173,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2605.2,,,2605.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3006,,,3006,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3006,,,3006,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3006,,,3006,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3006,,,3006,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3206.4,,,3206.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3072.8,,,3072.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2839,,,2839,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3173,,,3173,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3006,,,3006,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2605.2,3206.4,
HC RINGLOC BI-POLAR 28X47MM,Sx0011-165218,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3360,3024,3192,,,3024,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2620.8,,,2620.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024,,,2796.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024,,,1712.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024,,,2796.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.4,,,1712.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3024,,,3024,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3225.6,,,3225.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2469.6,,,2620.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1662.86,,,2620.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3091.2,,,3091.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.4,,,1712.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2856,,,2856,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3192,,,3024,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024,,,3192,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.4,,,1646.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2620.8,3225.6,
HC INSERTION PICC W/RS&I 5 YR/>,Px00036110260,CDM,36573,CPT,761,RC,,,,BOTH,,,3361,3024.9,3192.95,,,3024.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2621.58,,,2621.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024.9,,,2797.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024.9,,,1712.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024.9,,,2797.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.89,,,1712.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3024.9,,,3024.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3226.56,,,3226.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2470.34,,,2621.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1646.89,,,2621.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3092.12,,,3092.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.89,,,1712.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2856.85,,,2856.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3192.95,,,3024.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3024.9,,,3192.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1646.89,,,1646.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2621.58,3226.56,
HC DRILL ASNIS III CANNULATED 5.6MM LG AO,Sx00000702611,CDM,,,270,RC,,,,BOTH,,,3369,3032.1,3200.55,,,3032.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2627.82,,,2627.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3032.1,,,2804.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3032.1,,,1716.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3032.1,,,2804.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1650.81,,,1716.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3032.1,,,3032.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234.24,,,3234.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2476.22,,,2627.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1667.32,,,2627.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3099.48,,,3099.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1650.81,,,1716.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2863.65,,,2863.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3200.55,,,3032.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3032.1,,,3200.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1650.81,,,1650.81,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2627.82,3234.24,
HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST,Px00061010068,CDM,73223,CPT,610,RC,,,,BOTH,,,3385,3046.5,3215.75,,,3046.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2640.3,,,2640.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3046.5,,,2817.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3046.5,,,1725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3046.5,,,2817.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1658.65,,,1725,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3046.5,,,3046.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3249.6,,,3249.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.98,,,2640.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1658.65,,,2640.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3114.2,,,3114.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1658.65,,,1725,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2877.25,,,2877.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3215.75,,,3046.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3046.5,,,3215.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1658.65,,,1658.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2640.3,3249.6,
HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST,Px00061010079,CDM,73723,CPT,610,RC,,,,BOTH,,,3387,3048.3,3217.65,,,3048.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2641.86,,,2641.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.3,,,2819.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.3,,,1726.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.3,,,2819.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1659.63,,,1726.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3048.3,,,3048.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3251.52,,,3251.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2489.45,,,2641.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1659.63,,,2641.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3116.04,,,3116.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1659.63,,,1726.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2878.95,,,2878.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3217.65,,,3048.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.3,,,3217.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1659.63,,,1659.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2641.86,3251.52,
HC R&B-SEMI-PRIVATE OB,Px00012010020,CDM,,,120,RC,,,,INPATIENT,,,3390,2117.7,3220.5,,,3220.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2644.2,,,2644.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3051,,,3051,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3051,,,3051,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3051,,,3051,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3051,,,3051,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3254.4,,,3254.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3118.8,,,3118.8,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2881.5,,,2881.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3220.5,,,3220.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3051,,,3051,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,2644.2,3254.4,
HC MRI LUMBAR SPINE W/O & W/DYE,Px00061210017,CDM,72158,CPT,610,RC,,,,BOTH,,,3395,3055.5,3225.25,,,3055.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2648.1,,,2648.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3055.5,,,2826,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3055.5,,,1730.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3055.5,,,2826,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1663.55,,,1730.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3055.5,,,3055.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3259.2,,,3259.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2495.33,,,2648.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1663.55,,,2648.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3123.4,,,3123.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1663.55,,,1730.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2885.75,,,2885.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3225.25,,,3055.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3055.5,,,3225.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1663.55,,,1663.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2648.1,3259.2,
HC ED INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> CDM,Px00045010077,CDM,36556,CPT,450,RC,,,,OUTPATIENT,,,3428,2439,3256.6,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2673.84,,,2325.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2481.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,1519.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2481.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1519.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3290.88,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2519.58,,,2325.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1696.52,,,2325.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3153.76,,,2742.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1519.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2913.8,,,2533.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3256.6,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2831.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1679.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2673.84,3290.88,
HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> CDM,Px00045010080,CDM,36569,CPT,450,RC,,,,OUTPATIENT,,,3428,2439,3256.6,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2673.84,,,2325.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2481.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,1519.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2481.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1519.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3290.88,,,2861.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2519.58,,,2325.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1696.52,,,2325.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3153.76,,,2742.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1519.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2913.8,,,2533.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3256.6,,,2682.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3085.2,,,2831.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1679.72,,,1679.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2673.84,3290.88,
HC DISTAL LATERAL FIBULA PLATE 3 HOLE,Sx00040-20903,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3429,3086.1,3257.55,,,3086.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2674.62,,,2674.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3086.1,,,2854.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3086.1,,,1747.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3086.1,,,2854.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1680.21,,,1747.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3086.1,,,3086.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3291.84,,,3291.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2520.32,,,2674.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1697.01,,,2674.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3154.68,,,3154.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1680.21,,,1747.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2914.65,,,2914.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3257.55,,,3086.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3086.1,,,3257.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1680.21,,,1680.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2674.62,3291.84,
HC ALLOGRAFT HUMAN TISSUE EPIFIX 6SQCM 2CM X 3CM,Sx0000GS-5230,CDM,Q4186,HCPCS,278,RC,,,,BOTH,,,3433.5,3090.15,3261.83,,,3090.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2678.13,,,2678.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3090.15,,,2858.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3090.15,,,1749.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3090.15,,,2858.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1682.42,,,1749.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3090.15,,,3090.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3296.16,,,3296.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2523.62,,,2678.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1699.24,,,2678.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3158.82,,,3158.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1682.42,,,1749.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2918.48,,,2918.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3261.83,,,3090.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3090.15,,,3261.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1682.42,,,1682.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2678.13,3296.16,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML,Rx13533080024,CDM,J1561,HCPCS,636,RC,13533080024,NDC,,BOTH,200,ML,3449.77,3842.71,3277.28,,,3277.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2690.82,,,2690.82,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3104.79,,,3104.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3104.79,,,3104.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3104.79,,,3104.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.39,,,1690.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3104.79,,,3104.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3311.78,,,3311.78,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2535.58,,,2535.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,1690.39,,,1690.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3173.79,,,3173.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.39,,,1690.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2932.3,,,2932.3,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3277.28,,,3277.28,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3104.79,,,3104.79,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,1690.39,,,1690.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2690.82,3311.78,
HC VOLAR SMARTLOCK DR PLATE STANDARD RIGHT,Sx00054-25386,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3472.8,3125.52,3299.16,,,3125.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2708.78,,,2708.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3125.52,,,2890.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3125.52,,,1769.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3125.52,,,2890.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1701.67,,,1769.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3125.52,,,3125.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3333.89,,,3333.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2552.51,,,2708.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1718.69,,,2708.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3194.98,,,3194.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1701.67,,,1769.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2951.88,,,2951.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3299.16,,,3125.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3125.52,,,3299.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1701.67,,,1701.67,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2708.78,3333.89,
HC MRI BRAIN W/O & W/DYE,Px00061110015,CDM,70553,CPT,610,RC,,,,BOTH,,,3493,3143.7,3318.35,,,3143.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2724.54,,,2724.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3143.7,,,2907.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3143.7,,,1780.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3143.7,,,2907.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1711.57,,,1780.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3143.7,,,3143.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3353.28,,,3353.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2567.36,,,2724.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1711.57,,,2724.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3213.56,,,3213.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1711.57,,,1780.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2969.05,,,2969.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3318.35,,,3143.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3143.7,,,3318.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1711.57,,,1711.57,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2724.54,3353.28,
HC LAG SCREW TI 10.5 X 95MM,Sx03060-0095S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3528,3175.2,3351.6,,,3175.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2751.84,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,2936.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,1797.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,2936.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1728.72,,,1797.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3175.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3386.88,,,3386.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2593.08,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1746.01,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3245.76,,,3245.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1728.72,,,1797.87,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2998.8,,,2998.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3351.6,,,3175.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3351.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1728.72,,,1728.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2751.84,3386.88,
ABATACEPT FOR IV SOLN 250 MG,Rx00003218713,CDM,J0129,HCPCS,636,RC,3218713,NDC,,BOTH,250,ME,3552.35,3018.88,3374.73,,,3197.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2770.83,,,2771.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3197.12,,,2957.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3197.12,,,1810.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3197.12,,,2957.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1740.65,,,1810.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3197.12,,,3197.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3410.26,,,3411,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2610.98,,,2771.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1740.65,,,2771.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3268.16,,,3268.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1740.65,,,1810.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3019.5,,,3020.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3374.73,,,3197.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3197.12,,,3375.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1740.65,,,1740.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2770.83,3410.26,
HC VOLAR SMARTLOCK DR PLATE LEFT NARROW 56MM,Sx00054-25374,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3566.58,3209.92,3388.25,,,3209.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2781.93,,,2781.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3209.92,,,2968.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3209.92,,,1817.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3209.92,,,2968.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1747.62,,,1817.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3209.92,,,3209.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3423.92,,,3423.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2621.44,,,2781.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1765.1,,,2781.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3281.25,,,3281.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1747.62,,,1817.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3031.59,,,3031.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.25,,,3209.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3209.92,,,3388.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1747.62,,,1747.62,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2781.93,3423.92,
HC MRI ORBIT/FACE/NECK WO & W CONTRAST,Px00061010007,CDM,70543,CPT,610,RC,,,,BOTH,,,3578,3220.2,3399.1,,,3220.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2790.84,,,2790.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3220.2,,,2978.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3220.2,,,1823.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3220.2,,,2978.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1753.22,,,1823.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3220.2,,,3220.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3434.88,,,3434.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2629.83,,,2790.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1753.22,,,2790.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3291.76,,,3291.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1753.22,,,1823.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3041.3,,,3041.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3399.1,,,3220.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3220.2,,,3399.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1753.22,,,1753.22,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2790.84,3434.88,
HC ALL POLY PATELLA VE CEMENTED 32MM DIA 8.5MM THICKNESS,Sx42-5402-000,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3600,3240,3420,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2808,,,2808,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,2996.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,1834.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,2996.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1834.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3456,,,3456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2808,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1781.64,,,2808,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3312,,,3312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1834.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3060,,,3060,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3420,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,3420,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1764,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2808,3456,
HC TIBIAL INSERT FB SZ 4 RT 7MM,Sx00350-22-14,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3600,3240,3420,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2808,,,2808,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,2996.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,1834.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,2996.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1834.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3456,,,3456,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2808,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1781.64,,,2808,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3312,,,3312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1834.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3060,,,3060,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3420,,,3240,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3240,,,3420,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1764,,,1764,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2808,3456,
HC NOVASURE DISPOSABLE DEVICE W/BLUE HANDLE,Sx000NS2013US,CDM,,,270,RC,,,,BOTH,,,3605,3244.5,3424.75,,,3244.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2811.9,,,2811.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3244.5,,,3000.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3244.5,,,1837.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3244.5,,,3000.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1766.45,,,1837.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3244.5,,,3244.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3460.8,,,3460.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2649.68,,,2811.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1784.11,,,2811.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3316.6,,,3316.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1766.45,,,1837.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3064.25,,,3064.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3424.75,,,3244.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3244.5,,,3424.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1766.45,,,1766.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2811.9,3460.8,
HC BROAD STRAIGHT PLATE 7 HOLE T10,Sx00000626977,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3634.8,3271.32,3453.06,,,3271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2835.14,,,2835.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.32,,,3025.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.32,,,1852.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.32,,,3025.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1781.05,,,1852.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3271.32,,,3271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3489.41,,,3489.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2671.58,,,2835.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1798.86,,,2835.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3344.02,,,3344.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1781.05,,,1852.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3089.58,,,3089.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3453.06,,,3271.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.32,,,3453.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1781.05,,,1781.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2835.14,3489.41,
HC MRI ABDOMEN WO & W CONTRAST,Px00061010087,CDM,74183,CPT,610,RC,,,,BOTH,,,3658,3292.2,3475.1,,,3292.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2853.24,,,2853.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3292.2,,,3044.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3292.2,,,1864.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3292.2,,,3044.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1792.42,,,1864.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3292.2,,,3292.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3511.68,,,3511.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2688.63,,,2853.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1792.42,,,2853.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3365.36,,,3365.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1792.42,,,1864.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3109.3,,,3109.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3475.1,,,3292.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3292.2,,,3475.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1792.42,,,1792.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2853.24,3511.68,
HC MRI ABDOMEN W CONTRAST,Px00061010085,CDM,74182,CPT,610,RC,,,,BOTH,,,3673,3305.7,3489.35,,,3305.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2864.94,,,2864.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3305.7,,,3057.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3305.7,,,1871.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3305.7,,,3057.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1799.77,,,1871.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3305.7,,,3305.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3526.08,,,3526.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2699.66,,,2864.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1799.77,,,2864.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3379.16,,,3379.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1799.77,,,1871.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3122.05,,,3122.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3489.35,,,3305.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3305.7,,,3489.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1799.77,,,1799.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2864.94,3526.08,
HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST,Px00061010053,CDM,73720,CPT,610,RC,,,,BOTH,,,3676,3308.4,3492.2,,,3308.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2867.28,,,2867.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3308.4,,,3059.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3308.4,,,1873.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3308.4,,,3059.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1801.24,,,1873.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3308.4,,,3308.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3528.96,,,3528.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2701.86,,,2867.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1801.24,,,2867.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3381.92,,,3381.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1801.24,,,1873.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3124.6,,,3124.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3492.2,,,3308.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3308.4,,,3492.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1801.24,,,1801.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2867.28,3528.96,
HC MESH PROCEED HERNIA 8X10 PCDH1 0,Sx000000PCDH1,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,3803.01,3528.01,3612.86,,,3528.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2966.35,,,3057.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3422.71,,,3263.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3422.71,,,1997.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3422.71,,,3263.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1863.47,,,1997.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3422.71,,,3528.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3650.89,,,3763.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2795.21,,,3057.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1882.11,,,3057.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3498.77,,,3606.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1863.47,,,1997.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3232.56,,,3332.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3612.86,,,3528.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3422.71,,,3724.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1863.47,,,1863.47,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2966.35,3650.89,
HC VAGINAL DELIVERY LEVEL 1 CDM,Px00072210001,CDM,,,722,RC,,,,INPATIENT,,,3805,2377.8,3614.75,,,2853,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2967.9,,,2472.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3424.5,,,2638.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3424.5,,,1615.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3424.5,,,2638.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1864.45,,,1615.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3424.5,,,2853,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.8,,,3043.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2796.68,,,2472.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1864.45,,,2472.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3500.6,,,2916.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1864.45,,,1615.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3234.25,,,2694.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3614.75,,,2853,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3424.5,,,3011.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1864.45,,,1864.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2967.9,3652.8,
HC VOLAR DR PLATE LEFT 11 HOLE SHORT,Sx00054-25674,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,3808.11,3427.3,3617.7,,,3427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2970.33,,,2970.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3427.3,,,3169.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3427.3,,,1940.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3427.3,,,3169.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1865.97,,,1940.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3427.3,,,3427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3655.79,,,3655.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2798.96,,,2970.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1884.63,,,2970.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3503.46,,,3503.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1865.97,,,1940.61,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3236.89,,,3236.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3617.7,,,3427.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3427.3,,,3617.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1865.97,,,1865.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2970.33,3655.79,
HC SCREW 10.5 X 105MM TI LAG,Sx03060-0105S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3810,3429,3619.5,,,3429,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2971.8,,,2971.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3429,,,3171.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3429,,,1941.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3429,,,3171.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1866.9,,,1941.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3429,,,3429,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3657.6,,,3657.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2800.35,,,2971.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1885.57,,,2971.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3505.2,,,3505.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1866.9,,,1941.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3238.5,,,3238.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3619.5,,,3429,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3429,,,3619.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1866.9,,,1866.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2971.8,3657.6,
"HC FACE,NECK,HAND,FEET,GENITALIA TOTAL TO 100 SQCM; 1ST 25 SQCM",Px00076110224,CDM,15275,CPT,761,RC,,,,BOTH,,,3819,3437.1,3628.05,,,3437.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2978.82,,,2978.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3437.1,,,3178.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3437.1,,,1946.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3437.1,,,3178.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1871.31,,,1946.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3437.1,,,3437.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3666.24,,,3666.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2806.97,,,2978.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1871.31,,,2978.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3513.48,,,3513.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1871.31,,,1946.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3246.15,,,3246.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3628.05,,,3437.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3437.1,,,3628.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1871.31,,,1871.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2978.82,3666.24,
HC MYOSURE REACH TISSUE REMOVAL DEVICE,Sx00010-403FC,CDM,,,270,RC,,,,BOTH,,,3834.99,3451.49,3643.24,,,3451.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2991.29,,,2991.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3451.49,,,3192.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3451.49,,,1954.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3451.49,,,3192.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1879.15,,,1954.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3451.49,,,3451.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3681.59,,,3681.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2818.72,,,2991.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1897.94,,,2991.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3528.19,,,3528.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1879.15,,,1954.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3259.74,,,3259.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3643.24,,,3451.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3451.49,,,3643.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1879.15,,,1879.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2991.29,3681.59,
HC MRI CHEST WO & W CONTRAST,Px00061010025,CDM,71552,CPT,610,RC,,,,BOTH,,,3845,3460.5,3652.75,,,3460.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2999.1,,,2999.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3460.5,,,3200.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3460.5,,,1959.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3460.5,,,3200.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1884.05,,,1959.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3460.5,,,3460.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3691.2,,,3691.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2826.08,,,2999.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1884.05,,,2999.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3537.4,,,3537.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1884.05,,,1959.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3268.25,,,3268.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.75,,,3460.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3460.5,,,3652.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1884.05,,,1884.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2999.1,3691.2,
HC APLIGRAF SKIN SUBSTITUTE,Sx000APLIGRAF,CDM,,,270,RC,,,,BOTH,,,3885,3496.5,3690.75,,,3496.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3030.3,,,3030.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3496.5,,,3233.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3496.5,,,1979.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3496.5,,,3233.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1903.65,,,1979.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3496.5,,,3496.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3729.6,,,3729.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2855.48,,,3030.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1922.69,,,3030.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3574.2,,,3574.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1903.65,,,1979.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3302.25,,,3302.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3690.75,,,3496.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3496.5,,,3690.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1903.65,,,1903.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3030.3,3729.6,
HC R&B-SEMI-PRIVATE MED SURG W/ TELE,Px00012010009,CDM,,,120,RC,,,,INPATIENT,,,3900,2641.5,3705,,,3705,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3042,,,3042,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3510,,,3510,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3510,,,3510,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3510,,,3510,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3510,,,3510,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3744,,,3744,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3588,,,3588,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3315,,,3315,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3705,,,3705,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3510,,,3510,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3042,3744,
HC SUPERIOR PL DECREASED 7 HOLE R,Sx00000628027,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,3926.43,3533.79,3730.11,,,3533.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3062.62,,,3062.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3533.79,,,3268.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3533.79,,,2000.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3533.79,,,3268.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1923.95,,,2000.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3533.79,,,3533.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3769.37,,,3769.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2885.93,,,3062.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1943.19,,,3062.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3612.32,,,3612.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1923.95,,,2000.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3337.47,,,3337.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3730.11,,,3533.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3533.79,,,3730.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1923.95,,,1923.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3062.62,3769.37,
HC MYOSURE FMS-XL TISSUE REMOVAL DEVICE,Sx00050-603XL,CDM,,,270,RC,,,,BOTH,,,3936,3542.4,3739.2,,,3542.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3070.08,,,3070.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3542.4,,,3276.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3542.4,,,2005.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3542.4,,,3276.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1928.64,,,2005.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3542.4,,,3542.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3778.56,,,3778.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2892.96,,,3070.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,1947.93,,,3070.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3621.12,,,3621.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1928.64,,,2005.79,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3345.6,,,3345.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3739.2,,,3542.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3542.4,,,3739.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1928.64,,,1928.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3070.08,3778.56,
HC OXF ANAT BRG LT SM SIZE 6 PMA,Sx00000159543,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING ARCOM RIGHT SMALL SZ4,Sx00000159569,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING LEFT MEDIAL MEDIUM 4MM THICK,Sx00000159548,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC OXF ANAT BRG LT SM SIZE 4 PMA,Sx00000159541,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING ARCOM RIGHT MEDIAL,Sx00000159568,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC OXFORD ANATOMIC MENISCAL BEARING MED 6MM THICK,Sx00000159578,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING RIGHT MEDIAL XL 6MM THICK,Sx00000159592,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING ARCOM RIGHT MEDIAL MIDUIM 3MM,Sx00000159575,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING LEFT MEDIAL LARGE 4MM THICK,Sx00000159555,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING LEFT MEDIAL LARGE 3MM THICK,Sx00000159554,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC OXF ANAT BRG LT LG SIZE 5 PMA,Sx00000159556,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC OXF ANAT BRG LT LG SIZE 6 PMA,Sx00000159557,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC ANATOMIC MENISCAL BEARING ARCOM RIGHT SMALL SZ5,Sx00000159570,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4050,3645,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3159,,,3159,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,2063.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3371.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.35,,,3159,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3726,,,3726,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,2063.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3442.5,,,3442.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.5,,,3645,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3645,,,3847.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,1984.5,,,1984.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3159,3888,
HC VAGINAL DELIVERY LEVEL 2 CDM,Px00072210002,CDM,,,722,RC,,,,INPATIENT,,,4090,2557.8,3885.5,,,3069,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3190.2,,,2659.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3681,,,2838.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3681,,,1737.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3681,,,2838.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2004.1,,,1737.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3681,,,3069,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3926.4,,,3273.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3006.15,,,2659.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2004.1,,,2659.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3762.8,,,3137.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2004.1,,,1737.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3476.5,,,2898.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3885.5,,,3069,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3681,,,3239.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2004.1,,,2004.1,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3190.2,3926.4,
DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML,Rx55513071001,CDM,J0897,HCPCS,636,RC,55513071001,NDC,,BOTH,1,ML,4093.77,3352.92,3889.08,,,3684.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3193.14,,,3193.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.39,,,3407.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.39,,,2086.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.39,,,3407.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2005.95,,,2086.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3684.39,,,3684.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3930.02,,,3930.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3008.92,,,3193.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2005.95,,,3193.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3766.27,,,3766.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2005.95,,,2086.19,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3479.7,,,3479.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.08,,,3684.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.39,,,3889.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2005.95,,,2005.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3193.14,3930.02,
"HC GRAFT TRUNK,ARM.LEG, TOTAL TO 100 SQCM; 1ST 25 SQCM",Px00076110220,CDM,15271,CPT,761,RC,,,,BOTH,,,4094,3684.6,3889.3,,,3684.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3193.32,,,3193.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.6,,,3407.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.6,,,2086.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.6,,,3407.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2006.06,,,2086.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3684.6,,,3684.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3930.24,,,3930.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3009.09,,,3193.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2006.06,,,3193.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3766.48,,,3766.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2006.06,,,2086.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3479.9,,,3479.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.3,,,3684.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3684.6,,,3889.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2006.06,,,2006.06,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3193.32,3930.24,
HC VOLAR SMARTLOCK DR PLATE LEFT LONG 76MM,Sx00054-25377,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4116.21,3704.59,3910.4,,,3704.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3210.64,,,3210.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3704.59,,,3426.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3704.59,,,2097.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3704.59,,,3426.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2016.94,,,2097.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3704.59,,,3704.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3951.56,,,3951.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3025.41,,,3210.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2037.11,,,3210.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3786.91,,,3786.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2016.94,,,2097.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3498.78,,,3498.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3910.4,,,3704.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3704.59,,,3910.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2016.94,,,2016.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3210.64,3951.56,
HC ED CLOSED TX RADIUS HD FRACTURE CDM,Px00045010756,CDM,24655,CPT,450,RC,,,,OUTPATIENT,,,4118,2929.5,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3212.04,,,2793.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,1824.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3953.28,,,3437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3026.73,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2038,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3788.56,,,3294.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3500.3,,,3043.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3401.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,2017.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3212.04,3953.28,
HC ED TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM,Px00045010801,CDM,25565,CPT,450,RC,,,,OUTPATIENT,,,4118,2929.5,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3212.04,,,2793.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,1824.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3953.28,,,3437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3026.73,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2038,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3788.56,,,3294.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3500.3,,,3043.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3401.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,2017.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3212.04,3953.28,
HC ED CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM,Px00045010179,CDM,27752,CPT,450,RC,,,,OUTPATIENT,,,4118,2929.5,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3212.04,,,2793.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,1824.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3953.28,,,3437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3026.73,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2038,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3788.56,,,3294.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3500.3,,,3043.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3401.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,2017.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3212.04,3953.28,
HC ED CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM,Px00045010195,CDM,27781,CPT,450,RC,,,,OUTPATIENT,,,4118,2929.5,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3212.04,,,2793.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,1824.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,2980.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3953.28,,,3437.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3026.73,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2038,,,2793.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3788.56,,,3294.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,1824.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3500.3,,,3043.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3912.1,,,3222.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3706.2,,,3401.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2017.82,,,2017.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3212.04,3953.28,
HC ED TREAT DISLOCATION/FRACTURE W/SURG NK FX CDM,Px00045010600,CDM,23675,CPT,450,RC,,,,OUTPATIENT,,,4148,2951.1,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3235.44,,,2813.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,1838.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.08,,,3462.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.78,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2052.85,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3816.16,,,3318.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3525.8,,,3065.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3426.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,2032.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3235.44,3982.08,
HC ED CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,Px00045010808,CDM,25605,CPT,450,RC,,,,OUTPATIENT,,,4148,2951.1,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3235.44,,,2813.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,1838.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.08,,,3462.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.78,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2052.85,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3816.16,,,3318.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3525.8,,,3065.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3426.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,2032.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3235.44,3982.08,
HC ED CLOSED TX ARTICULAR FRACTURE W/MANIP CDM,Px00045010974,CDM,26742,CPT,450,RC,,,,OUTPATIENT,,,4148,2951.1,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3235.44,,,2813.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,1838.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.08,,,3462.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.78,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2052.85,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3816.16,,,3318.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3525.8,,,3065.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3426.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,2032.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3235.44,3982.08,
HC ED TREATMENT OF ANKLE FRACTURE BIMALL W/MANIP CDM,Px00045013009,CDM,27810,CPT,450,RC,,,,OUTPATIENT,,,4148,2951.1,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3235.44,,,2813.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,1838.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.08,,,3462.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.78,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2052.85,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3816.16,,,3318.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3525.8,,,3065.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3426.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,2032.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3235.44,3982.08,
HC ED CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM,Px00045013015,CDM,27818,CPT,450,RC,,,,OUTPATIENT,,,4148,2951.1,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3235.44,,,2813.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,1838.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3002.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.08,,,3462.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3048.78,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2052.85,,,2813.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3816.16,,,3318.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,1838.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3525.8,,,3065.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3940.6,,,3246.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3733.2,,,3426.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2032.52,,,2032.52,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3235.44,3982.08,
HC METATARSAL JOINT IMPLANT 40,Sx0000LMP-40T,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4159.11,3743.2,3951.15,,,3743.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3244.11,,,3244.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3743.2,,,3462.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3743.2,,,2119.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3743.2,,,3462.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2037.96,,,2119.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3743.2,,,3743.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3992.75,,,3992.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3056.95,,,3244.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2058.34,,,3244.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3826.38,,,3826.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2037.96,,,2119.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3535.24,,,3535.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3951.15,,,3743.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3743.2,,,3951.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2037.96,,,2037.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3244.11,3992.75,
HC ED TREAT HUMERUS FRACTURE W/MANIPULATION CDM,Px00045010717,CDM,24535,CPT,450,RC,,,,OUTPATIENT,,,4175,2970,3966.25,,,3267,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3256.5,,,2831.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3757.5,,,3021.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3757.5,,,1849.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3757.5,,,3021.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2045.75,,,1849.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3757.5,,,3267,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4008,,,3484.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3068.63,,,2831.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2066.21,,,2831.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3841,,,3339.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2045.75,,,1849.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3548.75,,,3085.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3966.25,,,3267,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3757.5,,,3448.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2045.75,,,2045.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3256.5,4008,
HC ED INSERTION OF CHEST TUBE CDM,Px00045010785,CDM,32551,CPT,450,RC,,,,OUTPATIENT,,,4189,2980.8,3979.55,,,3278.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3267.42,,,2841.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3770.1,,,3032.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3770.1,,,1856.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3770.1,,,3032.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2052.61,,,1856.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3770.1,,,3278.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4021.44,,,3497.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3078.92,,,2841.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2073.14,,,2841.54,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3853.88,,,3351.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2052.61,,,1856.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3560.65,,,3096.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3979.55,,,3278.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3770.1,,,3460.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2052.61,,,2052.61,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3267.42,4021.44,
HC ED DRAINAGE OF SCROTUM ABSCESS CDM,Px00045010437,CDM,55100,CPT,450,RC,,,,OUTPATIENT,,,4192,2982.6,3982.4,,,3280.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3269.76,,,2843.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3772.8,,,3034.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3772.8,,,1857.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3772.8,,,3034.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2054.08,,,1857.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3772.8,,,3280.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4024.32,,,3499.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3081.12,,,2843.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2074.62,,,2843.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3856.64,,,3353.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2054.08,,,1857.49,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3563.2,,,3098.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3982.4,,,3280.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3772.8,,,3462.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2054.08,,,2054.08,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3269.76,4024.32,
HC PLATE 2.4/2.7MM VA-LOCKING NAVICULAR IMPL,Sx002.211.220,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4206,3785.4,3995.7,,,3785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3280.68,,,3280.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3785.4,,,3501.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3785.4,,,2143.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3785.4,,,3501.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2060.94,,,2143.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3785.4,,,3785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4037.76,,,4037.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3091.41,,,3280.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2081.55,,,3280.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3869.52,,,3869.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2060.94,,,2143.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3575.1,,,3575.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3995.7,,,3785.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3785.4,,,3995.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2060.94,,,2060.94,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3280.68,4037.76,
HC ED DRAINAGE OF HEMA/FLUID CDM,Px00045010316,CDM,10140,CPT,450,RC,,,,OUTPATIENT,,,4211,2996.1,4000.45,,,3295.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3284.58,,,2856.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3789.9,,,2640.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3789.9,,,234.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3789.9,,,2640.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2063.39,,,234.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3789.9,,,3295.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4042.56,,,159.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3095.09,,,2856.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2084.02,,,2856.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3874.12,,,3369.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2063.39,,,1866.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3579.35,,,3112.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4000.45,,,3295.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3789.9,,,3478.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2063.39,,,2063.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3284.58,4042.56,
HC ED PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM,Px00045010006,CDM,33016,CPT,450,RC,,,,OUTPATIENT,,,4232,3010.5,4020.4,,,3312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3300.96,,,2870.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3808.8,,,3063.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3808.8,,,1875.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3808.8,,,3063.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2073.68,,,1875.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3808.8,,,3312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4062.72,,,3532.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3110.52,,,2870.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2094.42,,,2870.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3893.44,,,3385.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2073.68,,,1875.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3597.2,,,3128,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4020.4,,,3312,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3808.8,,,3496,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2073.68,,,2073.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3300.96,4062.72,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML,Rx13533080025,CDM,J1561,HCPCS,636,RC,13533080025,NDC,,BOTH,200,ML,4271.8,3844.62,4058.21,,,3844.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3332,,,3332,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3844.62,,,3555.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3844.62,,,2176.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3844.62,,,3555.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2093.18,,,2176.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3844.62,,,3844.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4100.93,,,4100.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.77,,,3332,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2093.18,,,3332,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3930.06,,,3930.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2093.18,,,2176.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3631.03,,,3631.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4058.21,,,3844.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3844.62,,,4058.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2093.18,,,2093.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3332,4100.93,
HC R&B NURSERY/LEVEL 3,Px00017310001,CDM,,,172,RC,,,,INPATIENT,,,4320,2700,4104,,,4104,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3369.6,,,3369.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4147.2,,,4147.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4000,,,4000,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3974.4,,,3974.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3672,,,3672,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4104,,,4104,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3888,,,3888,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3369.6,4147.2,
HC MESH PRIMATRIX 5X5 HCPCS Q4110,Sx607-005-550,CDM,Q4118,HCPCS,278,RC,,,,BOTH,,,4322.19,3566.43,4106.08,,,3889.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3371.31,,,3371.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.97,,,3597.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.97,,,2202.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.97,,,3597.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2117.87,,,2202.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3889.97,,,3889.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4149.3,,,4149.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3176.81,,,3371.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2139.05,,,3371.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3976.41,,,3976.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2117.87,,,2202.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3673.86,,,3673.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4106.08,,,3889.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3889.97,,,4106.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2117.87,,,2117.87,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3371.31,4149.3,
HC PRIMUS FLEXIBLE GREAT TOE IMPLANT FGT SIZE 30,Sx0000FGT-30T,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4449.24,4004.32,4226.78,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3470.41,,,3470.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,3703.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,2267.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,3703.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2267.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4271.27,,,4271.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3270.19,,,3470.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2201.93,,,3470.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4093.3,,,4093.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2267.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3781.85,,,3781.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4226.78,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,4226.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2180.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3470.41,4271.27,
HC PRIMUS FLEXIBLE GREAT TOE IMPLANT FGT SIZE 50,Sx0000FGT-50T,CDM,L8642,HCPCS,278,RC,,,,BOTH,,,4449.24,4004.32,4226.78,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3470.41,,,3470.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,3703.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,2267.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,3703.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2267.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4271.27,,,4271.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3270.19,,,3470.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2201.93,,,3470.41,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4093.3,,,4093.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2267.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3781.85,,,3781.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4226.78,,,4004.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4004.32,,,4226.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2180.13,,,2180.13,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3470.41,4271.27,
HC IMPLANT SYSTEM MPFL BIOCOMPOSITE,SxAR-1360C-CP,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4461,4014.9,4237.95,,,4014.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3479.58,,,3479.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4014.9,,,3713.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4014.9,,,2273.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4014.9,,,3713.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2185.89,,,2273.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4014.9,,,4014.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4282.56,,,4282.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3278.84,,,3479.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2207.75,,,3479.58,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4104.12,,,4104.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2185.89,,,2273.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3791.85,,,3791.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4237.95,,,4014.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4014.9,,,4237.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2185.89,,,2185.89,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3479.58,4282.56,
HC DYNANITE NITI STAPLE WITH INSTURMENTATION 9W X 7L,SxAR-8717DS-0,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4485,4036.5,4260.75,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3498.3,,,3498.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,3733.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,2285.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,3733.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2285.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4305.6,,,4305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3296.48,,,3498.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2219.63,,,3498.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4126.2,,,4126.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2285.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3812.25,,,3812.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4260.75,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,4260.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2197.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3498.3,4305.6,
HC SYNDESMOSIS TIGHTROPE XP IMPLANT STAINLESS STEEL,Sx00AR-8925SS,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4485,4036.5,4260.75,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3498.3,,,3498.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,3733.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,2285.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,3733.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2285.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4305.6,,,4305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3296.48,,,3498.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2219.63,,,3498.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4126.2,,,4126.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2285.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3812.25,,,3812.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4260.75,,,4036.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4036.5,,,4260.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2197.65,,,2197.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3498.3,4305.6,
HC R&B-SEMI-PRIVATE ISOLATION,Px00012010011,CDM,,,120,RC,,,,INPATIENT,,,4570,3096,4341.5,,,4341.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3564.6,,,3564.6,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4113,,,4113,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4113,,,4113,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4113,,,4113,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4113,,,4113,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4387.2,,,4387.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4204.4,,,4204.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3884.5,,,3884.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4341.5,,,4341.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4113,,,4113,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3564.6,4387.2,
HC IMPLANT KIT FUSEFORCE 12x12MM SOLANA,Sx000FFS-1212,CDM,,,270,RC,,,,BOTH,,,4577.25,4119.53,4348.39,,,4119.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3570.26,,,3570.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4119.53,,,3810.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4119.53,,,2332.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4119.53,,,3810.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2242.85,,,2332.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4119.53,,,4119.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4394.16,,,4394.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3364.28,,,3570.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2265.28,,,3570.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4211.07,,,4211.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2242.85,,,2332.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3890.66,,,3890.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4348.39,,,4119.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4119.53,,,4348.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2242.85,,,2242.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3570.26,4394.16,
HC R&B-SEMI-PRIVATE SPECIAL CARE,Px00012010018,CDM,,,120,RC,,,,INPATIENT,,,4645,2903.4,4412.75,,,4412.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3623.1,,,3623.1,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4180.5,,,4180.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4180.5,,,4180.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4180.5,,,4180.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4180.5,,,4180.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4459.2,,,4459.2,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4273.4,,,4273.4,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3948.25,,,3948.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4412.75,,,4412.75,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4180.5,,,4180.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,3623.1,4459.2,
HC PLATE MTP V1 LONG RIGHT 8 HOLE,Sx000PLP10462,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4668,4201.2,4434.6,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3641.04,,,3641.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,3885.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,2378.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,3885.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2378.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4481.28,,,4481.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3430.98,,,3641.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2310.19,,,3641.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4294.56,,,4294.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2378.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3967.8,,,3967.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4434.6,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,4434.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2287.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3641.04,4481.28,
HC PLATE MTP V1 LONG LEFT 8 HOLE,Sx000PLP10461,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4668,4201.2,4434.6,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3641.04,,,3641.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,3885.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,2378.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,3885.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2378.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4481.28,,,4481.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3430.98,,,3641.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2310.19,,,3641.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4294.56,,,4294.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2378.81,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3967.8,,,3967.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4434.6,,,4201.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4201.2,,,4434.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2287.32,,,2287.32,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3641.04,4481.28,
HC VAGINAL DELIVERY LEVEL 3 CDM,Px00072210003,CDM,,,722,RC,,,,INPATIENT,,,4670,2917.8,4436.5,,,3501,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3642.6,,,3034.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4203,,,3238.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4203,,,1982.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4203,,,3238.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2288.3,,,1982.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4203,,,3501,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4483.2,,,3734.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3432.45,,,3034.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2288.3,,,3034.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4296.4,,,3578.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2288.3,,,1982.34,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3969.5,,,3306.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4436.5,,,3501,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4203,,,3695.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2288.3,,,2288.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3642.6,4483.2,
IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/200ML,Rx61953000503,CDM,J1572,HCPCS,636,RC,61953000503,NDC,,BOTH,200,ML,4680.43,4212.39,4446.41,,,4446.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3650.74,,,3650.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4212.39,,,4212.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4212.39,,,4212.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4212.39,,,4212.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2293.41,,,2293.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212.39,,,4212.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4493.21,,,4493.21,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3440.12,,,3440.12,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2293.41,,,2293.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4306,,,4306,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2293.41,,,2293.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3978.37,,,3978.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4446.41,,,4446.41,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4212.39,,,4212.39,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2293.41,,,2293.41,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3650.74,4493.21,
HC SYNDESMOSIS TIGHTROPE XP IMPLANT TI,Sx000AR-8925T,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4709.25,4036.5,4473.79,,,4238.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3673.22,,,3673.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4238.33,,,3919.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4238.33,,,2399.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4238.33,,,3919.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2307.53,,,2399.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4238.33,,,4238.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4520.88,,,4520.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3461.3,,,3673.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2330.61,,,3673.22,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4332.51,,,4332.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2307.53,,,2399.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4002.86,,,4002.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4473.79,,,4238.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4238.33,,,4473.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2307.53,,,2307.53,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3673.22,4520.88,
HC UNIVERSAL VAULTLOCK GLENOID MEDIUM,Sx0AR-9106-02,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,4725,4252.5,4488.75,,,4252.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3685.5,,,3685.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4252.5,,,3933.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4252.5,,,2407.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4252.5,,,3933.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.25,,,2407.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4252.5,,,4252.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4536,,,4536,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3472.88,,,3685.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2338.4,,,3685.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4347,,,4347,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.25,,,2407.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4016.25,,,4016.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4488.75,,,4252.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4252.5,,,4488.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.25,,,2315.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3685.5,4536,
HC MRA NECK WO & W CONTRAST,Px00061010015,CDM,70549,CPT,610,RC,,,,BOTH,,,4726,4253.4,4489.7,,,4253.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3686.28,,,3686.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4253.4,,,3933.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4253.4,,,2408.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4253.4,,,3933.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.74,,,2408.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4253.4,,,4253.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4536.96,,,4536.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3473.61,,,3686.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2315.74,,,3686.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4347.92,,,4347.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.74,,,2408.37,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4017.1,,,4017.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4489.7,,,4253.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4253.4,,,4489.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2315.74,,,2315.74,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3686.28,4536.96,
HC PRIMUS FLEXIBLE GREAT TOE IMPL SIZE 50 SILICONE ELASTOMER,Sx00000FGT-50,CDM,L8642,HCPCS,278,RC,,,,BOTH,,,4739.4,4265.46,4502.43,,,4265.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3696.73,,,3696.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.46,,,3945.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.46,,,2415.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.46,,,3945.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2322.31,,,2415.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4265.46,,,4265.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4549.82,,,4549.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3483.46,,,3696.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2345.53,,,3696.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4360.25,,,4360.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2322.31,,,2415.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4028.49,,,4028.49,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4502.43,,,4265.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.46,,,4502.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2322.31,,,2322.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3696.73,4549.82,
HC ED PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING CDM,Px00045010789,CDM,32556,CPT,450,RC,,,,OUTPATIENT,,,4842,3444.3,4599.9,,,3789,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3776.76,,,3283.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4357.8,,,3504.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4357.8,,,2145.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4357.8,,,3504.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2372.58,,,2145.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4357.8,,,3789,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4648.32,,,4041.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3558.87,,,3283.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2396.31,,,3283.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4454.64,,,3873.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2372.58,,,2145.42,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4115.7,,,3578.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4599.9,,,3789,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4357.8,,,3999.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2372.58,,,2372.58,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3776.76,4648.32,
GOLIMUMAB IV SOLN 50 MG/4ML,Rx57894035001,CDM,J1602,HCPCS,636,RC,57894035001,NDC,,BOTH,4,ML,4853.58,4371.56,4610.9,,,4369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3785.79,,,3786.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4368.22,,,4041.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4368.22,,,2473.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4368.22,,,4041.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2378.25,,,2473.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4368.22,,,4369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4659.44,,,4660.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3567.38,,,3786.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2378.25,,,3786.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4465.29,,,4466.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2378.25,,,2473.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4125.54,,,4126.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4610.9,,,4369.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4368.22,,,4611.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2378.25,,,2378.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3785.79,4659.44,
PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 1000 UNIT,Rx63833039701,CDM,J7168,HCPCS,636,RC,63833039701,NDC,,BOTH,1000,UN,4891.49,4402.34,4646.92,,,4646.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3815.36,,,3815.36,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4402.34,,,4402.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4402.34,,,4402.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4402.34,,,4402.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2396.83,,,2396.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4402.34,,,4402.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4695.83,,,4695.83,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3595.25,,,3595.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2396.83,,,2396.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4500.17,,,4500.17,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2396.83,,,2396.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4157.77,,,4157.77,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4646.92,,,4646.92,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4402.34,,,4402.34,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2396.83,,,2396.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3815.36,4695.83,
DANTROLENE SODIUM FOR IV SUSP 250 MG,Rx42367054032,CDM,J7999,HCPCS,636,RC,42367054032,NDC,,BOTH,250,ME,4932.23,4439.01,4685.62,,,4439.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3847.14,,,3847.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4439.01,,,4105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4439.01,,,2513.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4439.01,,,4105.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.79,,,2513.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4439.01,,,4439.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4734.94,,,4734.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3625.19,,,3847.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2416.79,,,3847.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4537.65,,,4537.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.79,,,2513.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4192.4,,,4192.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4685.62,,,4439.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4439.01,,,4685.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2416.79,,,2416.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3847.14,4734.94,
HC BEARING MOBILE POLY CORE 8MM,Sx0000400-142,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4965,4468.5,4716.75,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3872.7,,,3872.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4132.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,2530.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4132.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2530.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4766.4,,,4766.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3649.28,,,3872.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2457.18,,,3872.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4567.8,,,4567.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2530.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4220.25,,,4220.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4716.75,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4716.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2432.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3872.7,4766.4,
HC BEARING MOBILE POLY CORE 10MM,Sx000400-144F,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,4965,4468.5,4716.75,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3872.7,,,3872.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4132.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,2530.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4132.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2530.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4766.4,,,4766.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3649.28,,,3872.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2457.18,,,3872.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4567.8,,,4567.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2530.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4220.25,,,4220.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4716.75,,,4468.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4468.5,,,4716.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2432.85,,,2432.85,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3872.7,4766.4,
HC CT COLONOGRAPHY SCREENING,Px00035010026,CDM,74263,CPT,350,RC,,,,BOTH,,,5062,4555.8,4808.9,,,4555.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3948.36,,,3948.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4555.8,,,4213.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4555.8,,,2579.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4555.8,,,4213.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2480.38,,,2579.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4555.8,,,4555.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4859.52,,,4859.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3720.57,,,3948.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2505.18,,,3948.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4657.04,,,4657.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2480.38,,,2579.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4302.7,,,4302.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4808.9,,,4555.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4555.8,,,4808.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2480.38,,,2480.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3948.36,4859.52,
HC G7 LONGEVITY HIGHWALL 36MM F,Sx00020123606,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5076,4568.4,4822.2,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3959.28,,,3959.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4225.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,2586.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4225.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2586.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4872.96,,,4872.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3730.86,,,3959.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2512.11,,,3959.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4669.92,,,4669.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2586.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4314.6,,,4314.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4822.2,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4822.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2487.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3959.28,4872.96,
HC G7 LONGEVITY HIGH WALL 36MM F,Sx00020123605,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5076,4568.4,4822.2,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3959.28,,,3959.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4225.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,2586.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4225.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2586.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4872.96,,,4872.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3730.86,,,3959.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2512.11,,,3959.28,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4669.92,,,4669.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2586.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4314.6,,,4314.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4822.2,,,4568.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4568.4,,,4822.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2487.24,,,2487.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3959.28,4872.96,
HC MENISCAL ROOT REPAIR KIT BIOCOMPOSITE,Sx00AR-4550BC,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5100,4590,4845,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3978,,,3978,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4245.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,2598.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4245.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2499,,,2598.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4896,,,4896,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3748.5,,,3978,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2523.99,,,3978,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4692,,,4692,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2499,,,2598.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4335,,,4335,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4845,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4845,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2499,,,2499,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3978,4896,
HC UNIVERSAL GLENOID BASEPLATE SM,Sx0AR-9120-01,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5145,4630.5,4887.75,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4013.1,,,4013.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4282.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,2621.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4282.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2621.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4939.2,,,4939.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3781.58,,,4013.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2546.26,,,4013.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4733.4,,,4733.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2621.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4373.25,,,4373.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4887.75,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4887.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2521.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4013.1,4939.2,
HC UNIVERSAL GLENOID BASEPLATE MEDIUM,Sx0AR-9120-02,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5145,4630.5,4887.75,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4013.1,,,4013.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4282.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,2621.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4282.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2621.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4939.2,,,4939.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3781.58,,,4013.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2546.26,,,4013.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4733.4,,,4733.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2621.89,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4373.25,,,4373.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4887.75,,,4630.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4887.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2521.05,,,2521.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4013.1,4939.2,
HC SPEEDBRIDGE IMPLANT SYSTEM W/BIOCOMPOSITE SWIVELOCK,SxAR-2600SBS-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5220,4698,4959,,,6095.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4071.6,,,5282.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,5637.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,3451.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,5637.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,3451.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,6095.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5011.2,,,6501.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3836.7,,,5282.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2583.38,,,5282.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4802.4,,,6230.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,3451.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4437,,,5756.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4959,,,6095.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,6433.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,2557.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4071.6,5011.2,
HC TKL SPEEDBRIDGE IMP SYS W/BC SWVLK & NDL,SxAR-2600SBS-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5220,6095.25,4959,,,6095.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4071.6,,,5282.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,5637.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,3451.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,5637.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,3451.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,6095.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5011.2,,,6501.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3836.7,,,5282.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2583.38,,,5282.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4802.4,,,6230.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,3451.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4437,,,5756.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4959,,,6095.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698,,,6433.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2557.8,,,2557.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4071.6,5011.2,
HC VAGINAL DELIVERY LEVEL 4 CDM,Px00072210004,CDM,,,722,RC,,,,INPATIENT,,,5245,3277.8,4982.75,,,3933,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4091.1,,,3408.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4720.5,,,3637.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4720.5,,,2226.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4720.5,,,3637.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.05,,,2226.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4720.5,,,3933,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5035.2,,,4195.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3855.08,,,3408.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2570.05,,,3408.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4825.4,,,4020.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.05,,,2226.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4458.25,,,3714.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4982.75,,,3933,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4720.5,,,4151.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2570.05,,,2570.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4091.1,5035.2,
HC USP II HUMERAL HEAD 50/19,SxAR-9150-19P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5250,4725,4987.5,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4095,,,4095,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4370.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,2675.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4370.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2675.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5040,,,5040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3858.75,,,4095,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2598.23,,,4095,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4830,,,4830,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2675.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4462.5,,,4462.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4987.5,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4987.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2572.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4095,5040,
HC USP II HUMERAL HEAD 50/21,SxAR-9150-21P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5250,4725,4987.5,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4095,,,4095,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4370.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,2675.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4370.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2675.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5040,,,5040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3858.75,,,4095,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2598.23,,,4095,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4830,,,4830,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2675.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4462.5,,,4462.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4987.5,,,4725,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4725,,,4987.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2572.5,,,2572.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4095,5040,
HC G7 PPS LTD ACET SHELL 46B,Sx00010000660,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5280,4752,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4118.4,,,4118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,2690.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5068.8,,,5068.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3880.8,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2613.07,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4857.6,,,4857.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4488,,,4488,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,5016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2587.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4118.4,5068.8,
HC G7 PPS LTD ACET SHELL 54F,Sx00010000664,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5280,4752,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4118.4,,,4118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,2690.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5068.8,,,5068.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3880.8,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2613.07,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4857.6,,,4857.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4488,,,4488,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,5016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2587.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4118.4,5068.8,
HC G7 PPS LTD ACET SHELL 50D,Sx00010000662,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5280,4752,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4118.4,,,4118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,2690.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5068.8,,,5068.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3880.8,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2613.07,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4857.6,,,4857.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4488,,,4488,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,5016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2587.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4118.4,5068.8,
HC G7 PPS LTD ACET SHELL 56F,Sx00010000665,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5280,4752,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4118.4,,,4118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,2690.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5068.8,,,5068.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3880.8,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2613.07,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4857.6,,,4857.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4488,,,4488,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,5016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2587.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4118.4,5068.8,
HC G7 PPS LTD ACET SHELL 58F,Sx00010000666,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5280,4752,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4118.4,,,4118.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,2690.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4395.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5068.8,,,5068.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3880.8,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2613.07,,,4118.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4857.6,,,4857.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2690.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4488,,,4488,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5016,,,4752,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4752,,,5016,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2587.2,,,2587.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4118.4,5068.8,
HC R&B-SEMI-PRIVATE MED SURG TELEMETRY ISOLATION,Px00012010024,CDM,,,120,RC,,,,INPATIENT,,,5350,4815,5082.5,,,5082.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4173,,,4173,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4815,,,4815,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4815,,,4815,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4815,,,4815,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4815,,,4815,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5136,,,5136,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.75,,,6554.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4922,,,4922,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4175,,,4175,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4547.5,,,4547.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5082.5,,,5082.5,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4815,,,4815,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3840.9,,,4216.75,per diem,Zero Instances of Item of service in the 12 months prior to posting the file,4173,5136,
HC UNIVERS REVERS SUTURE CUP 36 +2 LEFT,SxAR-9502F-26,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5355,4819.5,5087.25,,,4819.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4176.9,,,4176.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4819.5,,,4457.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4819.5,,,2728.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4819.5,,,4457.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2623.95,,,2728.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4819.5,,,4819.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5140.8,,,5140.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3935.93,,,4176.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2650.19,,,4176.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4926.6,,,4926.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2623.95,,,2728.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4551.75,,,4551.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5087.25,,,4819.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4819.5,,,5087.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2623.95,,,2623.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4176.9,5140.8,
HC IASSIST KNEE 2 POD KIT,Sx20-8011-002,CDM,,,270,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD LEFT MEDIAL TIBIAL TRAY SZ C PMA,Sx00000154722,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD RIGHT MEDIAL TIBIAL TRAY SZ D PMA,Sx00000154725,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD LEFT MEDIAL TIBIAL TRAY SZ B PMA,Sx00000154720,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXF UNI TIB TRAY SZA LM/RL PMA,Sx00000154718,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC RIGHT MEDIAL TIBIAL TRAY CEMENTED,Sx00000154719,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD RIGHT MEDIAL TRAY C,Sx00000154723,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC MEDIAL TIBIAL RIGHT TRAY SIZE F RM PMA,Sx00000154776,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC STEM EXTENSION TAPERED CEMENTED 14MM +30MM LENGTH,Sx42-5570-001,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC LEFT MEDIAL TIBIAL TRAY CEMENTED,Sx00000154726,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC PSN STRAIGHT HYB ST 14 X +30 M,Sx42-5570-001,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD RIGHT MEDIAL TRAY AA,Sx00000159532,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC LEFT MEDIAL TIBIAL TRAY SZ AA,Sx00000159531,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXF ANAT BRG LT LG SIZE 6 PMA,Sx00000154724,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD RIGHT MEDIAL TRAY SZ B  PMA,Sx00000154721,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC OXFORD RIGHT MEDIAL TIBIAL TRAY SZ E PMA,Sx00000154727,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5400,4860,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4212,,,4212,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,2751.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4494.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5184,,,5184,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2672.46,,,4212,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4968,,,4968,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2751.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4590,,,4590,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5130,,,4860,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4860,,,5130,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2646,,,2646,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4212,5184,
HC ED ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER CDM,Px00045010861,CDM,51102,CPT,450,RC,,,,OUTPATIENT,,,5413,3851.1,5142.35,,,4236.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4222.14,,,3671.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4871.7,,,3918.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4871.7,,,2398.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4871.7,,,3918.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2652.37,,,2398.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4871.7,,,4236.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5196.48,,,4518.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3978.56,,,3671.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2678.89,,,3671.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4979.96,,,4330.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2652.37,,,2398.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4601.05,,,4000.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5142.35,,,4236.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4871.7,,,4471.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2652.37,,,2652.37,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4222.14,5196.48,
HC LINEAR ST 50CM 8 CONTACT TRIAL LEAD KIT,SxSC-2218-50E,CDM,,,270,RC,,,,BOTH,,,5445,4900.5,5172.75,,,4900.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4247.1,,,4247.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4900.5,,,4532.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4900.5,,,2774.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4900.5,,,4532.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2668.05,,,2774.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4900.5,,,4900.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5227.2,,,5227.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4002.08,,,4247.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2694.73,,,4247.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5009.4,,,5009.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2668.05,,,2774.77,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4628.25,,,4628.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5172.75,,,4900.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4900.5,,,5172.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2668.05,,,2668.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4247.1,5227.2,
BELIMUMAB FOR IV SOLN 400 MG,Rx49401010201,CDM,J0490,HCPCS,636,RC,49401010201,NDC,,BOTH,1,ML,5469.2,4849.53,5195.74,,,4922.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.98,,,4265.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4922.28,,,4552.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4922.28,,,2787.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4922.28,,,4552.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2679.91,,,2787.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4922.28,,,4922.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5250.43,,,5250.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4019.86,,,4265.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2679.91,,,4265.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5031.66,,,5031.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2679.91,,,2787.11,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4648.82,,,4648.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5195.74,,,4922.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4922.28,,,5195.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2679.91,,,2679.91,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4265.98,5250.43,
HC DIGIFUSE 2.0 0 DEG ANGLE,Sx00000DF2000,CDM,,,270,RC,,,,BOTH,,,5481.06,4932.95,5207.01,,,4932.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4275.23,,,4275.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4932.95,,,4562.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4932.95,,,2793.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4932.95,,,4562.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2685.72,,,2793.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4932.95,,,4932.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5261.82,,,5261.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4028.58,,,4275.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2712.58,,,4275.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5042.58,,,5042.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2685.72,,,2793.15,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4658.9,,,4658.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5207.01,,,4932.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4932.95,,,5207.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2685.72,,,2685.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4275.23,5261.82,
HC SUPERIOR PLATE DECREASED 6 HOLE LEFT,Sx00000628006,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5523,4970.7,5246.85,,,4970.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4307.94,,,4307.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4970.7,,,4597.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4970.7,,,2814.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4970.7,,,4597.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.27,,,2814.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4970.7,,,4970.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5302.08,,,5302.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4059.41,,,4307.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2733.33,,,4307.94,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5081.16,,,5081.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.27,,,2814.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4694.55,,,4694.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5246.85,,,4970.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4970.7,,,5246.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2706.27,,,2706.27,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4307.94,5302.08,
HC VOLAR SMARTLOCK DR PLATE NARROW RIGHT,Sx00054-25384,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5541,4986.9,5263.95,,,4986.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4321.98,,,4321.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4986.9,,,4612.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4986.9,,,2823.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4986.9,,,4612.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2715.09,,,2823.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4986.9,,,4986.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5319.36,,,5319.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4072.64,,,4321.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2742.24,,,4321.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5097.72,,,5097.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2715.09,,,2823.69,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4709.85,,,4709.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5263.95,,,4986.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4986.9,,,5263.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2715.09,,,2715.09,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4321.98,5319.36,
HC OLECRANON PLATE 4 HOLE LEFT,Sx00000629344,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5607,5046.3,5326.65,,,5046.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4373.46,,,4373.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5046.3,,,4667.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5046.3,,,2857.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5046.3,,,4667.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2747.43,,,2857.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5046.3,,,5046.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5382.72,,,5382.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4121.15,,,4373.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2774.9,,,4373.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5158.44,,,5158.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2747.43,,,2857.33,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4765.95,,,4765.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5326.65,,,5046.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5046.3,,,5326.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2747.43,,,2747.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4373.46,5382.72,
HC QUAD TENDON 11MM X 90MM FLEXIGRAFT WITH BONE BLOCK,Sx00000FQUADB,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,5610,5049,5329.5,,,5049,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4375.8,,,4375.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5049,,,4669.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5049,,,2858.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5049,,,4669.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2748.9,,,2858.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5049,,,5049,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5385.6,,,5385.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4123.35,,,4375.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2776.39,,,4375.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5161.2,,,5161.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2748.9,,,2858.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4768.5,,,4768.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5329.5,,,5049,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5049,,,5329.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2748.9,,,2748.9,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4375.8,5385.6,
HC UNIVERS REVERS SUTURE CUP 39 NEUTRAL,SxAR-9502F-39,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5622.75,4819.5,5341.61,,,5060.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4385.75,,,4385.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5060.48,,,4680.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5060.48,,,2865.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5060.48,,,4680.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2755.15,,,2865.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5060.48,,,5060.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5397.84,,,5397.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4132.72,,,4385.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2782.7,,,4385.75,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5172.93,,,5172.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2755.15,,,2865.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4779.34,,,4779.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5341.61,,,5060.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5060.48,,,5341.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2755.15,,,2755.15,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4385.75,5397.84,
HC STIMULAN RAPID CURE 10CC,Sx0000620-010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5685,5116.5,5400.75,,,5116.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4434.3,,,4434.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5116.5,,,4732.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5116.5,,,2897.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5116.5,,,4732.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.65,,,2897.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5116.5,,,5116.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5457.6,,,5457.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4178.48,,,4434.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2813.51,,,4434.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5230.2,,,5230.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.65,,,2897.08,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4832.25,,,4832.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400.75,,,5116.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5116.5,,,5400.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2785.65,,,2785.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4434.3,5457.6,
HC PRIMUS FLEXIBLE GREAT TOE IMPL SIZE 30 SILICONE ELASTOMER,Sx00000FGT-30,CDM,L8642,HCPCS,278,RC,,,,BOTH,,,5796,5216.4,5506.2,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4520.88,,,4520.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,4824.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,2953.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,4824.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2953.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5564.16,,,5564.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4260.06,,,4520.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2868.44,,,4520.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5332.32,,,5332.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2953.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4926.6,,,4926.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5506.2,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,5506.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2840.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4520.88,5564.16,
HC PRIMUS FLEXIBLE GREAT TOE IMPL SIZE 40 SILICONE ELASTOMER,Sx00000FGT-40,CDM,L8642,HCPCS,278,RC,,,,BOTH,,,5796,5216.4,5506.2,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4520.88,,,4520.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,4824.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,2953.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,4824.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2953.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5564.16,,,5564.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4260.06,,,4520.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2868.44,,,4520.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5332.32,,,5332.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2953.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4926.6,,,4926.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5506.2,,,5216.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5216.4,,,5506.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2840.04,,,2840.04,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4520.88,5564.16,
PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 1000 UNIT,Rx63833038702,CDM,J7168,HCPCS,636,RC,63833038702,NDC,,BOTH,1000,UN,5803.5,5014.22,5513.33,,,5223.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4526.73,,,4526.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5223.15,,,4830.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5223.15,,,2957.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5223.15,,,4830.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2843.72,,,2957.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5223.15,,,5223.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5571.36,,,5571.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4265.57,,,4526.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2843.72,,,4526.73,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5339.22,,,5339.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2843.72,,,2957.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4932.98,,,4932.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5513.33,,,5223.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5223.15,,,5513.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2843.72,,,2843.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4526.73,5571.36,
"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)",Rx13533031805,CDM,90375,CPT,636,RC,13533031805,NDC,,BOTH,5,ML,5909.71,5368.46,5614.22,,,5614.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4609.57,,,4609.57,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5318.74,,,5318.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5318.74,,,5318.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5318.74,,,5318.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2895.76,,,2895.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5318.74,,,5318.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5673.32,,,5673.32,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4343.64,,,4343.64,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,2895.76,,,2895.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5436.93,,,5436.93,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2895.76,,,2895.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5023.25,,,5023.25,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5614.22,,,5614.22,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5318.74,,,5318.74,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,2895.76,,,2895.76,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4609.57,5673.32,
HC VOLAR DR PLATE LEFT 8 HOLE EXTRA SHORT,Sx00054-25583,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,5919,5327.1,5623.05,,,5327.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4616.82,,,4616.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5327.1,,,4926.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5327.1,,,3016.32,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5327.1,,,4926.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2900.31,,,3016.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5327.1,,,5327.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5682.24,,,5682.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4350.47,,,4616.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2929.31,,,4616.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5445.48,,,5445.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2900.31,,,3016.32,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5031.15,,,5031.15,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5623.05,,,5327.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5327.1,,,5623.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2900.31,,,2900.31,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4616.82,5682.24,
HC HYPROCURE SIZE 08 SINUS TARSI STENT,Sx00000HYP-08,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,5970,5373,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4656.6,,,4656.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,3042.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5731.2,,,5731.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4387.95,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.55,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5492.4,,,5492.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5074.5,,,5074.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5671.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,2925.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4656.6,5731.2,
HC HYPROCURE SIZE 07 SINUS TARSI STENT,Sx00000HYP-07,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,5970,5373,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4656.6,,,4656.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,3042.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5731.2,,,5731.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4387.95,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.55,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5492.4,,,5492.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5074.5,,,5074.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5671.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,2925.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4656.6,5731.2,
HC HYPROCURE SIZE 9 SINUS TARSI STENT,Sx000HYPII-09,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,5970,5373,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4656.6,,,4656.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,3042.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5731.2,,,5731.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4387.95,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.55,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5492.4,,,5492.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5074.5,,,5074.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5671.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,2925.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4656.6,5731.2,
HC HYPROCURE SIZE 10 SINUS TARSI STENT,Sx000HYPII-10,CDM,L8699,HCPCS,278,RC,,,,BOTH,,,5970,5373,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4656.6,,,4656.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,3042.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,4969.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5731.2,,,5731.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4387.95,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2954.55,,,4656.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5492.4,,,5492.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,3042.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5074.5,,,5074.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5671.5,,,5373,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5373,,,5671.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2925.3,,,2925.3,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4656.6,5731.2,
HC IMPLANT SYS BIOCOMP ACHILLES SPEEDB W/JUMP,SxAR-8928BCJ-,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5985,5386.5,5685.75,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4668.3,,,4668.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,4981.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,3049.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,4981.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,3049.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5745.6,,,5745.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4398.98,,,4668.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2961.98,,,4668.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5506.2,,,5506.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,3049.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5087.25,,,5087.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5685.75,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,5685.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,2932.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4668.3,5745.6,
HC QUICKSET KIT 8CC MACROPOROUS CALCIUM PHOSPHATE,Sx000ABS-3008,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,5985,5386.5,5685.75,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4668.3,,,4668.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,4981.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,3049.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,4981.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,3049.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5745.6,,,5745.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4398.98,,,4668.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2961.98,,,4668.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5506.2,,,5506.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,3049.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5087.25,,,5087.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5685.75,,,5386.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5386.5,,,5685.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2932.65,,,2932.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4668.3,5745.6,
"HC ARTHREX ECLIPSE HUMERAL HEAD, 53/20",Sx0AR-9353-20,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6000,5400,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4680,,,4680,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,3057.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5760,,,5760,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4410,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2969.4,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5520,,,5520,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5100,,,5100,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5700,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,2940,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4680,5760,
"HC ARTHREX ECLIPSE HUMERAL HEAD, 47/18",Sx0AR-9347-18,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6000,5400,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4680,,,4680,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,3057.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5760,,,5760,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4410,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2969.4,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5520,,,5520,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5100,,,5100,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5700,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,2940,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4680,5760,
"HC ARTHREX ECLIPSE HUMERAL HEAD, 49/20",Sx0AR-9349-20,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6000,5400,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4680,,,4680,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,3057.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,4994.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5760,,,5760,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4410,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2969.4,,,4680,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5520,,,5520,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,3057.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5100,,,5100,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5700,,,5400,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5400,,,5700,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2940,,,2940,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4680,5760,
ADALIMUMAB PREFILLED SYRINGE KIT 40 MG/0.8ML,Rx00074379902,CDM,J0135,HCPCS,636,RC,74379902,NDC,,BOTH,0.8,ML,6028,5429.35,5726.6,,,5426.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4701.84,,,4702.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5425.2,,,5018.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5425.2,,,3072.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5425.2,,,5018.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2953.72,,,3072.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5425.2,,,5426.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5786.88,,,5788.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4430.58,,,4702.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2953.72,,,4702.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5545.76,,,5546.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2953.72,,,3072.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5123.8,,,5124.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5726.6,,,5426.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5425.2,,,5727.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2953.72,,,2953.72,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4701.84,5786.88,
CERTOLIZUMAB PEGOL FOR INJ KIT 2 X 200 MG,Rx50474070062,CDM,J0717,HCPCS,636,RC,50474070062,NDC,,BOTH,200,ME,6032.02,9188.78,5730.42,,,5428.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4704.98,,,4704.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5428.82,,,5021.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5428.82,,,3073.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5428.82,,,5021.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2955.69,,,3073.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5428.82,,,5428.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5790.74,,,5790.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4433.53,,,4704.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,2955.69,,,4704.98,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5549.46,,,5549.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2955.69,,,3073.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5127.22,,,5127.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5730.42,,,5428.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5428.82,,,5730.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2955.69,,,2955.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4704.98,5790.74,
HC ARTICULAR SURFACE MC RT 11MM TIBIA SIZE E-F/CR FEMUR 6-7,Sx42-5221-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC LF 18MM TIBIA SIZE G-H/CR FEMUR 8-11,Sx42-5121-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF L 10MM 12/GH,Sx42-5121-010,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF R 10MM 12/GH,Sx42-5221-010,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF L 12MM 4-5/EF,Sx42-5121-006,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 14MM TIBIA SIZE E-F/CR FEMUR 8-11,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 11MM TIBIA SIZE E-F/CR FEMUR 4-5,Sx42-5221-003,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF L 10MM 12/J,Sx42-5121-011,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF L 16MM 4-5/CD,Sx42-5121-003,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 11MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT RIGHT 12MM HEIGHT,Sx42-5221-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 16MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 10MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 12MM TIBIA SIZE E-F/CR FEMUR 8-11,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 16MM TIBIA SIZE E-F/CR FEMUR 6-7,Sx42-5221-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC LF 16MM TIBIA SIZE G-H/CR FEMUR 8-11,Sx42-5121-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 12MM HEIGHT,Sx42-5121-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 13MM HEIGHT,Sx42-5121-006,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,6075,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 14MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT RIGHT 10MM HEIGHT,Sx42-5221-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 10MM TIBIA SIZE E-F/CR FEMUR 8-11,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 13MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 10MM HEIGHT,Sx42-5121-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 11MM TIBIA SIZE G-H/CR FEMUR 8-11,Sx42-5221-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 12MM HEIGHT,Sx42-5121-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 10MM TIBIA SIZE E-F/CR FEMUR 6-7,Sx42-5221-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 12MM TIBIA SIZE E-F/CR FEMUR 6-7,Sx42-5221-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 10MM,Sx42-5121-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 11MM TIBIA SIZE E-F/CR FEMUR 8-11,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 13MM TIBIA SIZE EF FEMUR 8-11,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 10MM TIBIA SIZE J/CR FEMUR 12,Sx42-5221-011,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 14MM TIBIA SIZE E-F/CR FEMUR 6-7,Sx42-5221-007,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSNB MC VE ASF L 14MM 8-11 GH,Sx42-5121-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RIGHT 18MM,Sx42-5221-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC PSN MC VE ASF L 12MM 8-11 EF,Sx42-5121-008,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 14MM TIBIA SIZE G-H/CR FEMUR 8-11,Sx42-5221-009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,5467.5,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,4738.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3095.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,4738.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,5589,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3095.82,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5163.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,5467.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5771.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC ARTICULAR SURFACE MC RT 10MM TIBIA SIZE C-D/CR FEMUR 6-7,Sx42-5221-004,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6075,6075,5771.25,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4738.5,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4465.13,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3006.52,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5589,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5163.75,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5771.25,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5467.5,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,2976.75,,,2976.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4738.5,5832,
HC T2 STD. TIBIAL NAIL 10mmX315mm,Sx01822-1031S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6201.45,5581.31,5891.38,,,5581.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4837.13,,,4837.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5581.31,,,5162.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5581.31,,,3160.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5581.31,,,5162.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3038.71,,,3160.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5581.31,,,5581.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.39,,,5953.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4558.07,,,4837.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3069.1,,,4837.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5705.33,,,5705.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3038.71,,,3160.26,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5271.23,,,5271.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5891.38,,,5581.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5581.31,,,5891.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3038.71,,,3038.71,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4837.13,5953.39,
HC UNIVERS REVERS GLENO 42 +4 LAT,SxAR-9504L-04,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6300,5670,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4914,,,4914,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,3210.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6048,,,6048,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3117.87,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5796,,,5796,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5355,,,5355,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5985,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3087,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4914,6048,
HC UNIVERS REVERS GLENO 36,Sx000AR-9504S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6300,5670,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4914,,,4914,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,3210.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6048,,,6048,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3117.87,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5796,,,5796,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5355,,,5355,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5985,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3087,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4914,6048,
HC UNIVERS REVERS GLENO 39,Sx000AR-9504M,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6300,5670,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4914,,,4914,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,3210.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6048,,,6048,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3117.87,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5796,,,5796,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5355,,,5355,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5985,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3087,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4914,6048,
HC UNIVERS REVERS GLENO 36 +4 LAT,SxAR-9504S-04,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6300,5670,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4914,,,4914,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,3210.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5244.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6048,,,6048,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4630.5,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3117.87,,,4914,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5796,,,5796,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3210.48,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5355,,,5355,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5985,,,5670,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5670,,,5985,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3087,,,3087,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4914,6048,
HC SLIDING CORE 9MM POLY COMPONENT,Sx000400-143F,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6315,5683.5,5999.25,,,5683.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4925.7,,,4925.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5683.5,,,5256.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5683.5,,,3218.12,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5683.5,,,5256.61,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3094.35,,,3218.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5683.5,,,5683.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6062.4,,,6062.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4641.53,,,4925.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3125.29,,,4925.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5809.8,,,5809.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3094.35,,,3218.12,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5367.75,,,5367.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5999.25,,,5683.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5683.5,,,5999.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3094.35,,,3094.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4925.7,6062.4,
INCLISIRAN SODIUM SUBCUTANEOUS SOLN PREF SYR 284 MG/1.5ML,Rx00078100060,CDM,J1306,HCPCS,636,RC,78100060,NDC,,BOTH,1.5,ML,6392.56,5612.13,6072.93,,,5753.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4986.2,,,4986.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.3,,,5321.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.3,,,3257.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.3,,,5321.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3132.35,,,3257.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5753.3,,,5753.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6136.86,,,6136.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4698.53,,,4986.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3132.35,,,4986.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5881.16,,,5881.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3132.35,,,3257.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5433.68,,,5433.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6072.93,,,5753.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.3,,,6072.94,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3132.35,,,3132.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4986.2,6136.86,
HC G7 VIT E HIGH WALL LNR 32MM B,Sx00030123202,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
HC G7 VIT E HIGH WALL LNR 32MM D,Sx00030123204,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
HC G7 VIT E HIGH WALL LNR 36MM F,Sx00030123606,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
HC G7 VIT E HIGH WALL LNR 36MM D,Sx00030123604,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
HC G7 VIT E HIGH WALL LNR 36MM G,Sx00030123607,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
HC G7 VIT E HIGH WALL LNR 36MM E,Sx00030123605,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6408,5767.2,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4998.24,,,4998.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,3265.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5334.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6151.68,,,6151.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4709.88,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3171.32,,,4998.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5895.36,,,5895.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3265.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5446.8,,,5446.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6087.6,,,5767.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5767.2,,,6087.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3139.92,,,3139.92,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4998.24,6151.68,
TENECTEPLASE FOR IV SOLN KIT 50 MG,Rx50242012001,CDM,J3101,HCPCS,636,RC,50242012001,NDC,,BOTH,50,ME,6409.45,5768.51,6088.98,,,6088.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4999.37,,,4999.37,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5768.51,,,5768.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5768.51,,,5768.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5768.51,,,5768.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3140.63,,,3140.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5768.51,,,5768.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6153.07,,,6153.07,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,4710.95,,,4710.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3140.63,,,3140.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5896.69,,,5896.69,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3140.63,,,3140.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5448.03,,,5448.03,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6088.98,,,6088.98,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5768.51,,,5768.51,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3140.63,,,3140.63,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,4999.37,6153.07,
TOCILIZUMAB IV INJ 400 MG/20ML,Rx50242013701,CDM,J3262,HCPCS,636,RC,50242013701,NDC,,BOTH,20,ML,6450.94,5810.28,6128.39,,,5807.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5031.73,,,5032.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5805.85,,,5370.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5805.85,,,3288.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5805.85,,,5370.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3160.96,,,3288.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5805.85,,,5807.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6192.9,,,6194.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4741.44,,,5032.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3160.96,,,5032.86,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5934.86,,,5936.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3160.96,,,3288.13,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5483.3,,,5484.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6128.39,,,5807.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5805.85,,,6129.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3160.96,,,3160.96,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5031.73,6192.9,
HC VIVACIT-E DM BEARING 28X38MM SIZE C,Sx00110031009,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6480,5832,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5054.4,,,5054.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,3302.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6220.8,,,6220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4762.8,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3206.95,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5961.6,,,5961.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5508,,,5508,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,6156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3175.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5054.4,6220.8,
HC VIVACIT-E DM BEARING 28X42MM SIZE E,Sx00110031011,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6480,5832,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5054.4,,,5054.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,3302.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6220.8,,,6220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4762.8,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3206.95,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5961.6,,,5961.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5508,,,5508,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,6156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3175.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5054.4,6220.8,
HC VIVACIT-E DM BEARING 28X38MM SIZE D,Sx00110031010,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6480,5832,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5054.4,,,5054.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,3302.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6220.8,,,6220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4762.8,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3206.95,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5961.6,,,5961.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5508,,,5508,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,6156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3175.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5054.4,6220.8,
HC VIVACIT-E DM BEARING 28X46MM SIZE G,Sx00110031013,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6480,5832,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5054.4,,,5054.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,3302.21,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5393.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6220.8,,,6220.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4762.8,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3206.95,,,5054.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5961.6,,,5961.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3302.21,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5508,,,5508,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6156,,,5832,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5832,,,6156,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3175.2,,,3175.2,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5054.4,6220.8,
HC SUPERIOR PLATE DECREASED 6 HOLE RIGHT,Sx00000628026,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6495,5845.5,6170.25,,,5845.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5066.1,,,5066.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5845.5,,,5406.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5845.5,,,3309.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5845.5,,,5406.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3182.55,,,3309.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5845.5,,,5845.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6235.2,,,6235.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4773.83,,,5066.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3214.38,,,5066.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5975.4,,,5975.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3182.55,,,3309.85,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5520.75,,,5520.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6170.25,,,5845.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5845.5,,,6170.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3182.55,,,3182.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5066.1,6235.2,
HC BASEPLATE MODULAR 28MM +2 LAT,SxAR-9560-28-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6600,5940,6270,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5148,,,5148,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5493.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,3363.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5493.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3363.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6336,,,6336,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4851,,,5148,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3266.34,,,5148,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6072,,,6072,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3363.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5610,,,5610,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6270,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,6270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3234,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5148,6336,
HC 24MM BASEPLATE MODULAR,Sx0AR-9560-24,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6600,5940,6270,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5148,,,5148,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5493.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,3363.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5493.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3363.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6336,,,6336,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4851,,,5148,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3266.34,,,5148,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6072,,,6072,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3363.36,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5610,,,5610,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6270,,,5940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5940,,,6270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3234,,,3234,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5148,6336,
HC SUBTALAR MBA IMPLANT 9MM,Sx00000050109,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6629.01,5966.11,6297.56,,,5966.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5170.63,,,5170.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5966.11,,,5517.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5966.11,,,3378.14,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5966.11,,,5517.99,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3248.21,,,3378.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5966.11,,,5966.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6363.85,,,6363.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4872.32,,,5170.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3280.7,,,5170.63,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6098.69,,,6098.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3248.21,,,3378.14,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5634.66,,,5634.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6297.56,,,5966.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5966.11,,,6297.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3248.21,,,3248.21,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5170.63,6363.85,
HC PROXIMAL LATERAL HUMERUS PLATE RIGHT HUMERUS 3 HOLE L86MM,Sx00000627233,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6677.13,6009.42,6343.27,,,6009.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5208.16,,,5208.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6009.42,,,5558.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6009.42,,,3402.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6009.42,,,5558.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.79,,,3402.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6009.42,,,6009.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6410.04,,,6410.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4907.69,,,5208.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3304.51,,,5208.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6142.96,,,6142.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.79,,,3402.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5675.56,,,5675.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6343.27,,,6009.42,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6009.42,,,6343.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3271.79,,,3271.79,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5208.16,6410.04,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE J,Sx42-5320-088,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE D,Sx42-5320-067,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC ARTICULAR SURFACE MEDICAL CONGRUENT LEFT 14MM HEIGHT,Sx42512100814,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE F,Sx42-5320-075,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE E,Sx42-5320-071,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RIGHT SIZE H,Sx42-5320-083,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RIGHT SIZE F,Sx42-5320-075,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE H,Sx42-5320-083,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RIGHT SIZE D,Sx42-5320-067,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED LEFT SIZE G,Sx42-5320-079,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RIGHT SIZE G,Sx42-5320-079,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RT SIZE E,Sx42-5320-071,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC NATURAL TIBIA CEMENTED 5 DEG STEMMED RIGHT SIZE J,Sx42-5320-088,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
HC PSN ASF CPS 165MM LEFT TIB SZ G-H FEMUR 6-9,Sx42-5126-009,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,6750,6075,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5265,,,5265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,3439.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,5618.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6480,,,6480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3340.58,,,5265,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3439.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5737.5,,,5737.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.5,,,6075,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6075,,,6412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3307.5,,,3307.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5265,6480,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML,Rx13533080040,CDM,J1561,HCPCS,636,RC,13533080040,NDC,,BOTH,400,ML,6899.54,5510.3,6554.56,,,6554.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5381.64,,,5381.64,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6209.59,,,6209.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6209.59,,,6209.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6209.59,,,6209.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3380.77,,,3380.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6209.59,,,6209.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6623.56,,,6623.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,5071.16,,,5071.16,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,3380.77,,,3380.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6347.58,,,6347.58,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3380.77,,,3380.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5864.61,,,5864.61,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6554.56,,,6554.56,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,6209.59,,,6209.59,PERCENT OF TOTAL BILLED CHARGES,Zero Instances of Item of service in the 12 months prior to posting the file,3380.77,,,3380.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5381.64,6623.56,
HC GLENOSPHERE 39 + 4 LAT/28,SxAR-9564-283,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6900,6210,6555,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5382,,,5382,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,3516.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3381,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6624,,,6624,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5071.5,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3414.81,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6348,,,6348,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3381,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5865,,,5865,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6555,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6210,,,6555,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3381,,,3381,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5382,6624,
HC BEARING MOBILE POLY CORE 6MM,Sx0000400-140,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6915,4468.5,6569.25,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5393.7,,,5393.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,5756.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,3523.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,5756.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3523.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6638.4,,,6638.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5082.53,,,5393.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3422.23,,,5393.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6361.8,,,6361.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3523.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5877.75,,,5877.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6569.25,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,6569.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3388.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5393.7,6638.4,
HC BEARING MOBILE POLY CORE 7MM,Sx0000400-141,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6915,4468.5,6569.25,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5393.7,,,5393.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,5756.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,3523.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,5756.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3523.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6638.4,,,6638.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5082.53,,,5393.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3422.23,,,5393.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6361.8,,,6361.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3523.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5877.75,,,5877.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6569.25,,,6223.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6223.5,,,6569.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3388.35,,,3388.35,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5393.7,6638.4,
HC BASEPLATE MODULAR 24MM +4 LAT,SxAR-9560-24-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6930,6237,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5405.4,,,5276.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,3447.445,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.445,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6652.8,,,6494.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5093.55,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3429.66,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6375.6,,,6223.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5890.5,,,5750.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6426.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3395.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5405.4,6652.8,
HC BASEPLATE MODULAR LAT 24MM+2,SxAR-9560-24-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6930,5940,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5405.4,,,5276.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,3447.445,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.445,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6652.8,,,6494.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5093.55,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3429.66,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6375.6,,,6223.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5890.5,,,5750.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6426.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3395.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5405.4,6652.8,
HC BASEPLATE MODULAR 24MM +2 LAT,SxAR-9560-24-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,6930,6237,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5405.4,,,5276.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,3447.445,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,5631.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.445,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6652.8,,,6494.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5093.55,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3429.66,,,5276.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6375.6,,,6223.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3447.45,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5890.5,,,5750.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6583.5,,,6088.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6237,,,6426.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3395.7,,,3395.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5405.4,6652.8,
HC GLENOSPHERE 33/24,SxAR-9564-243,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7245,6210,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5651.1,,,5382,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,3516.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6955.2,,,6624,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5325.08,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3585.55,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6665.4,,,6348,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6158.25,,,5865,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6555,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3550.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5651.1,6955.2,
HC GLENOSPHERE 33 + 4 LAT/24,SxAR-9564-243,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7245,6210,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5651.1,,,5382,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,3516.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6955.2,,,6624,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5325.08,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3585.55,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6665.4,,,6348,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6158.25,,,5865,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6555,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3550.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5651.1,6955.2,
HC GLENOSPHERE 36 + 4 LAT/24,SxAR-9564-243,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7245,6520.5,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5651.1,,,5382,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,3516.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,5743.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6955.2,,,6624,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5325.08,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3585.55,,,5382,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6665.4,,,6348,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3516.24,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6158.25,,,5865,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6882.75,,,6210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6520.5,,,6555,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3550.05,,,3550.05,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5651.1,6955.2,
HC UNIVERS REVERS HUMERAL STEM SIZE 12,SxAR-9501-12P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7455,6709.5,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5814.9,,,5814.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,3799.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7156.8,,,7156.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5479.43,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3689.48,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6858.6,,,6858.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6336.75,,,6336.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,7082.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3652.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5814.9,7156.8,
HC UNIVERS REVERS HUMERAL STEM SIZE 8,SxAR-9501-08P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7455,6709.5,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5814.9,,,5814.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,3799.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7156.8,,,7156.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5479.43,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3689.48,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6858.6,,,6858.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6336.75,,,6336.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,7082.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3652.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5814.9,7156.8,
HC UNIVERS REVERS HUMERAL STEM SIZE 7,SxAR-9501-07P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7455,6709.5,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5814.9,,,5814.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,3799.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7156.8,,,7156.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5479.43,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3689.48,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6858.6,,,6858.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6336.75,,,6336.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,7082.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3652.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5814.9,7156.8,
HC UNIVERS REVERS HUMERAL STEM SIZE 11,SxAR-9501-11P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,7455,6709.5,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5814.9,,,5814.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,3799.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7156.8,,,7156.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5479.43,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3689.48,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6858.6,,,6858.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6336.75,,,6336.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7082.25,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6709.5,,,7082.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3652.95,,,3652.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5814.9,7156.8,
PEGFILGRASTIM SOLN PREFILLED SYRINGE 6 MG/0.6ML,Rx55513019001,CDM,J2506,HCPCS,636,RC,55513019001,NDC,,BOTH,0.6,ML,7488.62,6744.91,7114.19,,,6741.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5841.12,,,5842.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6739.76,,,6234.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6739.76,,,3817.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6739.76,,,6234.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3669.42,,,3817.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6739.76,,,6741.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7189.08,,,7190.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5504.14,,,5842.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3669.42,,,5842.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6889.53,,,6891.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3669.42,,,3817.04,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6365.33,,,6366.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7114.19,,,6741.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6739.76,,,7115.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3669.42,,,3669.42,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5841.12,7189.08,
HC CONSTRAINED POSTERIOR STABILIZ RIGHT 10MM TIB SIZE G-H,Sx42-5226-010,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7500,6750,7125,,,6750,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5850,,,5850,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6750,,,6243,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6750,,,3822,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6750,,,6243,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3675,,,3822,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6750,,,6750,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7200,,,7200,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5512.5,,,5850,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3711.75,,,5850,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6900,,,6900,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3675,,,3822,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6375,,,6375,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7125,,,6750,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6750,,,7125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3675,,,3675,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5850,7200,
HC NAIL GALILEOTROCH RIGHT 10MMX42CMX125,Sx0001021-425,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,7599.37,6839.43,7219.4,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5927.51,,,5927.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6325.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,3872.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6325.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3872.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7295.4,,,7295.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5585.54,,,5927.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3760.93,,,5927.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6991.42,,,6991.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3872.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6459.46,,,6459.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7219.4,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,7219.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3723.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5927.51,7295.4,
HC NAIL ES TROCH RIGHT 10MMX39CMX125,Sx0001021-395,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,7599.37,6839.43,7219.4,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5927.51,,,5927.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6325.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,3872.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6325.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3872.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7295.4,,,7295.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5585.54,,,5927.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3760.93,,,5927.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6991.42,,,6991.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3872.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6459.46,,,6459.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7219.4,,,6839.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6839.43,,,7219.41,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3723.69,,,3723.69,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,5927.51,7295.4,
IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML,Rx13533080041,CDM,J1561,HCPCS,636,RC,13533080041,NDC,,BOTH,400,ML,7812.2,7030.98,7421.59,,,7030.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6093.52,,,6093.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7030.98,,,6502.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7030.98,,,3981.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7030.98,,,6502.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3827.98,,,3981.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7030.98,,,7030.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7499.71,,,7499.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5741.97,,,6093.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3827.98,,,6093.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7187.22,,,7187.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3827.98,,,3981.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6640.37,,,6640.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7421.59,,,7030.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7030.98,,,7421.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3827.98,,,3827.98,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6093.52,7499.71,
HC UNIVERS REVERS HUMERAL STEM SIZE 6,SxAR-9501-06P,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,7827.75,6709.5,7436.36,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6105.65,,,5814.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,3799.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6205.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7514.64,,,7156.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.4,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3873.95,,,5814.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7201.53,,,6858.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3799.07,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6653.59,,,6336.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7436.36,,,6709.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7082.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3835.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6105.65,7514.64,
HC UNIVERS REVERS HUMERAL STEM SIZE 5,SxAR-9501-05P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7827.75,7044.98,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6105.65,,,6105.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,3989.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7514.64,,,7514.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.4,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3873.95,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7201.53,,,7201.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6653.59,,,6653.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7436.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3835.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6105.65,7514.64,
HC UNIVERS REVERS HUMERAL STEM SIZE 10,SxAR-9501-10P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7827.75,7044.98,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6105.65,,,6105.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,3989.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7514.64,,,7514.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.4,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3873.95,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7201.53,,,7201.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6653.59,,,6653.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7436.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3835.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6105.65,7514.64,
HC UNIVERS REVERS HUMERAL STEM SIZE 9,SxAR-9501-09P,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7827.75,6709.5,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6105.65,,,6105.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,3989.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,6515.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7514.64,,,7514.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5753.4,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3873.95,,,6105.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7201.53,,,7201.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3989.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6653.59,,,6653.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7436.36,,,7044.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7044.98,,,7436.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3835.6,,,3835.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6105.65,7514.64,
HC G7 DUAL ACETABULAR LINER NEUTRAL 38MM BEARING SIZE C,Sx00110024461,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7956,7160.4,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6205.68,,,6205.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,4054.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7637.76,,,7637.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5847.66,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3937.42,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7319.52,,,7319.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6762.6,,,6762.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7558.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,3898.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6205.68,7637.76,
HC G7 DUAL ACETABULAR LINER NEUTRAL 42MM BEARING SIZE E,Sx00110024463,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7956,7160.4,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6205.68,,,6205.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,4054.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7637.76,,,7637.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5847.66,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3937.42,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7319.52,,,7319.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6762.6,,,6762.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7558.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,3898.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6205.68,7637.76,
HC G7 DUAL ACETABULAR LINER NEUTRAL 38MM BEARING SIZE D,Sx00110024462,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,7956,7160.4,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6205.68,,,6205.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,4054.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,6622.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7637.76,,,7637.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5847.66,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3937.42,,,6205.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7319.52,,,7319.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,4054.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6762.6,,,6762.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7558.2,,,7160.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7160.4,,,7558.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3898.44,,,3898.44,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6205.68,7637.76,
OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG,Rx00078081881,CDM,J2353,HCPCS,636,RC,78081881,NDC,,BOTH,20,ME,7959.08,6890.27,7561.13,,,7164.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6208.08,,,6209.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7163.17,,,6626.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7163.17,,,4056.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7163.17,,,6626.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3899.95,,,4056.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7163.17,,,7164.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7640.72,,,7642.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5849.92,,,6209.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,3899.95,,,6209.43,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7322.35,,,7323.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3899.95,,,4056.83,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6765.22,,,6766.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7561.13,,,7164.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7163.17,,,7562.77,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3899.95,,,3899.95,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6208.08,7640.72,
HC TWIN PEG FEMORAL CEMENTED,Sx00000161468,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,8100,7290,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6318,,,6318,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,4127.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7776,,,7776,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4008.69,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7452,,,7452,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6885,,,6885,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7695,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,3969,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6318,7776,
HC OXFORD TWIN PEG FEMORAL MEDIUM,Sx00000161469,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,8100,7290,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6318,,,6318,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,4127.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7776,,,7776,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4008.69,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7452,,,7452,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6885,,,6885,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7695,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,3969,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6318,7776,
HC CEMENTED TWIN PEGGED FEMORAL X-LARGE,Sx00000161471,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,8100,7290,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6318,,,6318,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,4127.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7776,,,7776,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4008.69,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7452,,,7452,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6885,,,6885,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7695,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,3969,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6318,7776,
HC TWIN PEG FEMORAL LG SIZE CEMENTED,Sx00000161470,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,8100,7290,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6318,,,6318,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,4127.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,6742.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7776,,,7776,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4008.69,,,6318,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7452,,,7452,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,4127.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6885,,,6885,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695,,,7290,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7290,,,7695,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,3969,,,3969,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6318,7776,
HC NAIL GALILEOTROCH LEFT 10MMX39CMX125,Sx0001020-390,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,8174.25,7356.83,7765.54,,,7356.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6375.92,,,6375.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7356.83,,,6804.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7356.83,,,4165.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7356.83,,,6804.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4005.38,,,4165.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7356.83,,,7356.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7847.28,,,7847.28,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6008.07,,,6375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4045.44,,,6375.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7520.31,,,7520.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4005.38,,,4165.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6948.11,,,6948.11,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7765.54,,,7356.83,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7356.83,,,7765.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4005.38,,,4005.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6375.92,7847.28,
TENECTEPLASE FOR IV SOLN KIT 50 MG,Rx50242012047,CDM,J3101,HCPCS,636,RC,50242012047,NDC,,BOTH,50,ME,8179.24,6944.05,7770.28,,,7362.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6379.81,,,6381.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7361.32,,,6809.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7361.32,,,4169.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7361.32,,,6809.89,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4007.83,,,4169.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7361.32,,,7362.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7852.07,,,7853.79,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6011.74,,,6381.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4007.83,,,6381.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7524.9,,,7526.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4007.83,,,4169.05,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6952.35,,,6953.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7770.28,,,7362.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7361.32,,,7771.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4007.83,,,4007.83,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6379.81,7852.07,
HC ETEX BETA BSM INJECTABLE BONE SUBSTITUTE 5CC,Sx000076-6016,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,8213.22,12528,7802.56,,,7391.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6406.31,,,6406.31,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7391.9,,,6836.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7391.9,,,4185.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7391.9,,,6836.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4024.48,,,4185.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7391.9,,,7391.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7884.69,,,7884.69,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6036.72,,,6406.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4064.72,,,6406.31,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7556.16,,,7556.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4024.48,,,4185.46,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6981.24,,,6981.24,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7802.56,,,7391.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7391.9,,,7802.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4024.48,,,4024.48,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6406.31,7884.69,
DIGOXIN IMMUNE FAB FOR INJ 40 MG,Rx50633012011,CDM,J1162,HCPCS,636,RC,50633012011,NDC,,BOTH,40,ME,8329.79,7213.91,7913.3,,,7498.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6497.24,,,6498.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7496.81,,,6935.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7496.81,,,4245.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7496.81,,,6935.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4081.6,,,4245.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7496.81,,,7498.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7996.6,,,7998.34,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6122.4,,,6498.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4081.6,,,6498.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7663.41,,,7665.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4081.6,,,4245.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7080.32,,,7081.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7913.3,,,7498.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7496.81,,,7915.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4081.6,,,4081.6,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6497.24,7996.6,
HC NAIL KIT 11 X 180MM X 125 TI TROCHANTERIC,Sx03125-1180S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,8382.5,7544.25,7963.38,,,7544.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6538.35,,,6538.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,6977.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,4271.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,6977.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4271.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,7544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8047.2,,,8047.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6161.14,,,6538.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4148.5,,,6538.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.9,,,7711.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4271.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7125.13,,,7125.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7963.38,,,7544.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,7963.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4107.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6538.35,8047.2,
HC NAIL KIT 11 X 180MM X 130 TI TROCHANTERIC,Sx03130-1180S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,8382.5,7544.25,7963.38,,,7544.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6538.35,,,6538.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,6977.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,4271.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,6977.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4271.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,7544.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8047.2,,,8047.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6161.14,,,6538.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4148.5,,,6538.35,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.9,,,7711.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4271.72,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7125.13,,,7125.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7963.38,,,7544.26,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7544.25,,,7963.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4107.43,,,4107.43,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6538.35,8047.2,
HC ED AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM,Px00045010239,CDM,26951,CPT,450,RC,,,,OUTPATIENT,,,8517,6059.7,8091.15,,,6665.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6643.26,,,5776.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7665.3,,,6164.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7665.3,,,3774.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7665.3,,,6164.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4173.33,,,3774.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7665.3,,,6665.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8176.32,,,7109.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6260,,,5776.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4215.06,,,5776.68,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7835.64,,,6813.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4173.33,,,3774.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7239.45,,,6295.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8091.15,,,6665.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7665.3,,,7035.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4173.33,,,4173.33,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6643.26,8176.32,
HC ALLOGRAFT HUMAN TISSUE EPIFIX 16SQCM 4CM X 4CM,Sx0000GS-5440,CDM,Q4186,HCPCS,278,RC,,,,BOTH,,,8686.5,7817.85,8252.18,,,7817.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6775.47,,,6775.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7817.85,,,7230.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7817.85,,,4426.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7817.85,,,7230.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4256.39,,,4426.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7817.85,,,7817.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8339.04,,,8339.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6384.58,,,6775.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4298.95,,,6775.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7991.58,,,7991.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4256.39,,,4426.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7383.53,,,7383.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8252.18,,,7817.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7817.85,,,8252.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4256.39,,,4256.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6775.47,8339.04,
HC SCP FOOT AND ANKLE KIT 11GA 3CC SIDE DELIVERY,Sx0000514.302,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,8700,7830,8265,,,7830,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6786,,,6786,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7830,,,7241.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7830,,,4433.52,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7830,,,7241.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4263,,,4433.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7830,,,7830,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8352,,,8352,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6394.5,,,6786,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4305.63,,,6786,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8004,,,8004,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4263,,,4433.52,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7395,,,7395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8265,,,7830,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7830,,,8265,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4263,,,4263,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6786,8352,
RITUXIMAB IV SOLN 500 MG/50ML,Rx50242005306,CDM,J9312,HCPCS,636,RC,50242005306,NDC,,BOTH,50,ML,8880.79,6394.2,8436.75,,,7992.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6927.02,,,6927.02,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7992.71,,,7392.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7992.71,,,4525.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7992.71,,,7392.37,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4351.59,,,4525.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7992.71,,,7992.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8525.56,,,8525.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6527.38,,,6927.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4351.59,,,6927.02,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8170.33,,,8170.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4351.59,,,4525.65,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7548.67,,,7548.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8436.75,,,7992.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7992.71,,,8436.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4351.59,,,4351.59,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,6927.02,8525.56,
HC CER BIOLOXD OPTION HD 36MM,Sx000650-1057,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,9028.5,8125.65,8577.08,,,8125.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7042.23,,,7042.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8125.65,,,7515.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8125.65,,,4600.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8125.65,,,7515.33,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4423.97,,,4600.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8125.65,,,8125.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8667.36,,,8667.36,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6635.95,,,7042.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4468.2,,,7042.23,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8306.22,,,8306.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4423.97,,,4600.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7674.23,,,7674.23,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8577.08,,,8125.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8125.65,,,8577.08,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4423.97,,,4423.97,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7042.23,8667.36,
HC MAXFORCE THICK 2X4CM,Sx00086MX2X04,CDM,Q4107,HCPCS,278,RC,,,,BOTH,,,9075,8167.5,8621.25,,,8167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7078.5,,,7078.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8167.5,,,7554.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8167.5,,,4624.62,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8167.5,,,7554.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4446.75,,,4624.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8167.5,,,8167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8712,,,8712,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6670.13,,,7078.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4491.22,,,7078.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8349,,,8349,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4446.75,,,4624.62,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7713.75,,,7713.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8621.25,,,8167.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8167.5,,,8621.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4446.75,,,4446.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7078.5,8712,
IDARUCIZUMAB IV SOLN 2.5 GM/50ML,Rx00597019705,CDM,J3590,HCPCS,636,RC,597019705,NDC,,BOTH,50,ML,9275.04,8026.57,8811.29,,,8347.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7234.53,,,7234.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8347.54,,,7720.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8347.54,,,4726.56,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8347.54,,,7720.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4544.77,,,4726.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8347.54,,,8347.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8904.04,,,8904.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6817.15,,,7234.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4544.77,,,7234.53,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8533.04,,,8533.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4544.77,,,4726.56,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7883.78,,,7883.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8811.29,,,8347.54,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8347.54,,,8811.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4544.77,,,4544.77,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7234.53,8904.04,
HC SLEP CROSS CHECK PLATE LAP 2 RIGHT,Sx005820LPX2R,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,9330,8397,8863.5,,,8397,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7277.4,,,7277.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8397,,,7766.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8397,,,4754.57,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8397,,,7766.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4571.7,,,4754.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8397,,,8397,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8956.8,,,8956.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6857.55,,,7277.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4617.42,,,7277.4,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8583.6,,,8583.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4571.7,,,4754.57,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7930.5,,,7930.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8863.5,,,8397,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8397,,,8863.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4571.7,,,4571.7,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7277.4,8956.8,
HC VOLAR DISTAL RAD PLATE 2.4 MM TI STD RT 3 HOLE KREULOCK,SxAR-8924VSR-,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,9375,8437.5,8906.25,,,8437.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7312.5,,,7312.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8437.5,,,7803.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8437.5,,,4777.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8437.5,,,7803.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4593.75,,,4777.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8437.5,,,8437.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9000,,,9000,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6890.63,,,7312.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4639.69,,,7312.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8625,,,8625,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4593.75,,,4777.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7968.75,,,7968.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8906.25,,,8437.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8437.5,,,8906.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4593.75,,,4593.75,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7312.5,9000,
COAGULATION FACT XA (RECOMB) INACT-ZHZO FOR IV SOLN 200 MG,Rx00310320001,CDM,J7169,HCPCS,636,RC,310320001,NDC,,BOTH,200,ME,9405.23,8464.71,8934.97,,,8464.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7336.08,,,7336.09,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8464.71,,,7828.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8464.71,,,4792.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8464.71,,,7828.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4608.56,,,4792.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8464.71,,,8464.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9029.02,,,9029.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6912.84,,,7336.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4608.56,,,7336.09,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8652.81,,,8652.82,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4608.56,,,4792.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7994.45,,,7994.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8934.97,,,8464.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8464.71,,,8934.98,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4608.56,,,4608.56,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7336.08,9029.02,
HC CLAW II U PLATE SMALL,Sx00040243010,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,9432,8488.8,8960.4,,,8488.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7356.96,,,7356.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8488.8,,,7851.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8488.8,,,4806.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8488.8,,,7851.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4621.68,,,4806.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8488.8,,,8488.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9054.72,,,9054.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6932.52,,,7356.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,4667.9,,,7356.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8677.44,,,8677.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4621.68,,,4806.55,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8017.2,,,8017.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8960.4,,,8488.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8488.8,,,8960.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4621.68,,,4621.68,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7356.96,9054.72,
HC FEMUR IMPLANT PSN FEM CR CMT CCR/STD SZ12 L,Sx42-5026-074,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,9112.5,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,7897.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,5159.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,9720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,9315,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,8606.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9618.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW LEFT SIZE 4,Sx42-5020-056,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,9112.5,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,7897.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,5159.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,9720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,9315,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,8606.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9618.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 5,Sx42-5020-058,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,9112.5,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,7897.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,5159.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,8428.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,9720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,7897.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,9315,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,5159.7,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,8606.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,9112.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,9618.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 10,Sx42-5020-068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,9112.5,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE NARROW RIGHT SIZE 11,Sx42-5020-070,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,9112.5,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE NARROW LEFT SIZE 11,Sx42-5020-070,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,10935,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 9,Sx42-5020-068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10125,10935,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7897.5,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9720,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7441.88,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5010.86,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9315,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8606.25,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9618.75,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9112.5,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,4961.25,,,4961.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,7897.5,9720,
HC UNIVERSAL APEX HUMERAL STEM 6MM,SxAR-9100-06S,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10437.5,9393.75,9915.63,,,9393.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8141.25,,,8141.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9393.75,,,8688.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9393.75,,,5318.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9393.75,,,8688.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5114.38,,,5318.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9393.75,,,9393.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10020,,,10020,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7671.56,,,8141.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5165.52,,,8141.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9602.5,,,9602.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5114.38,,,5318.95,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8871.88,,,8871.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9915.63,,,9393.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9393.75,,,9915.63,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5114.38,,,5114.38,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8141.25,10020,
HC AUGMENT BONE GRAFT 3CC KIT,Sx00K20003010,CDM,C1734,HCPCS,278,RC,,,,BOTH,,,10485,9436.5,9960.75,,,9436.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8178.3,,,8178.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9436.5,,,8727.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9436.5,,,5343.16,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9436.5,,,8727.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5137.65,,,5343.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9436.5,,,9436.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10065.6,,,10065.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7706.48,,,8178.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5189.03,,,8178.3,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9646.2,,,9646.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5137.65,,,5343.16,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8912.25,,,8912.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9960.75,,,9436.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9436.5,,,9960.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5137.65,,,5137.65,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8178.3,10065.6,
HC TALAR IMPLANT SZ 4 RT,Sx00350-02-04,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10500,9450,9975,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8190,,,8190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,8740.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,5350.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,8740.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5350.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10080,,,10080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7717.5,,,8190,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5196.45,,,8190,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9660,,,9660,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5350.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8925,,,8925,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9975,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,9975,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5145,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8190,10080,
HC SCP COMPLETE KNEE KIT WITH ACCUPORT SIDE DEL CANNULA,Sx0000414.502,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,10500,9450,9975,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8190,,,8190,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,8740.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,5350.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,8740.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5350.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10080,,,10080,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7717.5,,,8190,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5196.45,,,8190,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9660,,,9660,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5350.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8925,,,8925,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9975,,,9450,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9450,,,9975,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5145,,,5145,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8190,10080,
HC ECLIPSE TRUNION 45MM SLOTTED TPS CAP,SxAR-9301-45C,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,11250,10125,10687.5,,,10125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8775,,,8775,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10125,,,9364.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10125,,,5733,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10125,,,9364.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5512.5,,,5733,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10125,,,10125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10800,,,10800,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8268.75,,,8775,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5567.63,,,8775,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10350,,,10350,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5512.5,,,5733,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9562.5,,,9562.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10687.5,,,10125,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10125,,,10687.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5512.5,,,5512.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,8775,10800,
HC TPRLC 133 T1 PPS HO 14X148MM,Sx0051-104140,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,11550,10395,10972.5,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9009,,,9009,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,9614.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,5885.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,9614.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5885.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11088,,,11088,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8489.25,,,9009,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5716.1,,,9009,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10626,,,10626,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5885.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9817.5,,,9817.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10972.5,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,10972.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5659.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9009,11088,
HC TPRLC 133 T1 PPS HO 9X137MM,Sx0051-104090,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,11550,10395,10972.5,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9009,,,9009,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,9614.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,5885.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,9614.22,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5885.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11088,,,11088,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8489.25,,,9009,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,5716.1,,,9009,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10626,,,10626,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5885.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9817.5,,,9817.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10972.5,,,10395,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10395,,,10972.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5659.5,,,5659.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9009,11088,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 6,Sx42-5020-060,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING STD LEFT SIZE 8,Sx42-5026-064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,12150,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE LFT 7 RETAINING STD LEFT SIZE 7,Sx42-5026-062,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING STD RIGHT SIZE 9,Sx42-5026-066,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW LEFT SIZE 9,Sx42-5020-066,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 8,Sx42-5020-064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RT 7 RETAINING STD RIGHT SIZE 7,Sx42-5026-062,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE LFT 10 RETAINING STD LEFT SIZE 10,Sx42-5026-068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 7,Sx42-5020-062,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING STD LEFT SIZE 9,Sx42-5026-066,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW LEFT SIZE 6,Sx42-5020-060,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RT 10 RETAINING STD RIGHT SIZE 10,Sx42-5026-068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW LEFT SIZE 7,Sx42-5020-062,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CENENTED CRUCIATE LFT 11 RETAINING STD,Sx42-5026-070,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CENENTED CRUCIATE RT 11 RETAINING STD,Sx42-5026-070,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE LFT 6 RETAINING STD LEFT SIZE 6,Sx42-5026-060,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RT 6 RETAINING STD RIGHT SIZE 6,Sx42-5026-060,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC PSN FEM CR CMT CCR STD SZ5 L,Sx42-5026-058,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW LEFT SIZE 8,Sx42-5020-064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE RETAINING NARROW RIGHT SIZE 9,Sx42-5020-066,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED POSTERIOR STAB STANDARD LEFT SIZE 8,Sx42-5006-064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,10935,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCITATE RETAINING STD RIGHT SIZE 8,Sx42-5026-064,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,9112.5,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,9477,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6191.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10113.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,11664,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,9477,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,11178,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6191.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,10327.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,10935,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11542.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC FEMUR CEMENTED CRUCIATE LFT 4 RETAINING STD LEFT SIZE 4,Sx42-5026-056,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12150,12150,11542.5,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9477,,,10530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,6879.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11664,,,12960,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8930.25,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6013.04,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11178,,,12420,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10327.5,,,11475,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11542.5,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10935,,,12825,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,5953.5,,,5953.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9477,11664,
HC TIBIAL PLATE FB SZ 4 RT,Sx00350-12-04,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,12250,11025,11637.5,,,11025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9555,,,9555,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11025,,,10196.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11025,,,6242.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11025,,,10196.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6002.5,,,6242.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11025,,,11025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11760,,,11760,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9003.75,,,9555,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6062.53,,,9555,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11270,,,11270,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6002.5,,,6242.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10412.5,,,10412.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11637.5,,,11025,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11025,,,11637.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6002.5,,,6002.5,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9555,11760,
HC UNIVERSAL APEX HUMERAL STEM 11,SxAR-9100-11S,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,12525,11272.5,11898.75,,,11272.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9769.5,,,9769.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11272.5,,,10425.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11272.5,,,6382.74,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11272.5,,,10425.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6137.25,,,6382.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11272.5,,,11272.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12024,,,12024,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9205.88,,,9769.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6198.62,,,9769.5,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11523,,,11523,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6137.25,,,6382.74,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10646.25,,,10646.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11898.75,,,11272.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11272.5,,,11898.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6137.25,,,6137.25,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,9769.5,12024,
HC TPRLC 133 MP SP T1 PPS HO 7X99,Sx0051-109070,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13087.5,11778.75,12433.13,,,11778.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10208.25,,,10208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,10894.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,6669.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,10894.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6669.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,11778.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12564,,,12564,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9619.31,,,10208.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6477,,,10208.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12040.5,,,12040.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6669.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11124.38,,,11124.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12433.13,,,11778.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,12433.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6412.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10208.25,12564,
HC TPRLC 133 MP TYPE1 PPS HO 10.0,Sx0051-107100,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13087.5,11778.75,12433.13,,,11778.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10208.25,,,10208.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,10894.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,6669.39,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,10894.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6669.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,11778.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12564,,,12564,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9619.31,,,10208.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6477,,,10208.25,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12040.5,,,12040.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6669.39,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11124.38,,,11124.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12433.13,,,11778.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11778.75,,,12433.13,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6412.88,,,6412.88,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10208.25,12564,
HC FEMUR CEMENTED POSTERIOR STAB STANDARD RIGHT SIZE 10,Sx42-5006-068,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13500,12150,12825,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10530,,,10530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,6879.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12960,,,12960,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9922.5,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6681.15,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12420,,,12420,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11475,,,11475,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12825,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,12825,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6615,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10530,12960,
HC ECLIPSE TRUNION 47MM SLOTTED HEAD 47/18,SxAR-9301-47C,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,13500,12150,12825,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10530,,,10530,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,6879.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,11237.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12960,,,12960,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9922.5,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6681.15,,,10530,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12420,,,12420,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6879.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11475,,,11475,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12825,,,12150,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12150,,,12825,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6615,,,6615,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10530,12960,
HC TPRLC 133 T1 PPS HO 11X142MM,Sx0051-104110,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC TPRLC 133 T1 PPS HO 10X140MM,Sx0051-104100,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC TPRLC 133 T1 PPS HO 15X150MM,Sx0051-104150,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC TPRLC 133 T1 PPS HO 13X146MM,Sx0051-104130,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC TPRLC 133 T1 PPS HO 16X152MM,Sx0051-104160,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC TPRLC 133 FPTYPE 1 PPS HO 8.0,Sx0051-101080,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,13860,12474,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10810.8,,,10810.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,7063.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,11537.07,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13305.6,,,13305.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10187.1,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6859.31,,,10810.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12751.2,,,12751.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,7063.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11781,,,11781,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13167,,,12474,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12474,,,13167,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6791.4,,,6791.4,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10810.8,13305.6,
HC G7 OSSEOTI ACETABULAR MULTIHOLE 50MM D,Sx00110010263,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,14001,12600.9,13300.95,,,12600.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10920.78,,,10920.78,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12600.9,,,11654.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12600.9,,,7134.91,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12600.9,,,11654.43,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6860.49,,,7134.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12600.9,,,12600.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13440.96,,,13440.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10290.74,,,10920.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6929.09,,,10920.78,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12880.92,,,12880.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6860.49,,,7134.91,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11900.85,,,11900.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13300.95,,,12600.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12600.9,,,13300.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6860.49,,,6860.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10920.78,13440.96,
HC PLATE TIBIAL 40MM SBI IMPLANT,Sx0000400-263,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,14064,12657.6,13360.8,,,12657.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10969.92,,,10969.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12657.6,,,11706.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12657.6,,,7167.01,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12657.6,,,11706.87,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6891.36,,,7167.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12657.6,,,12657.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13501.44,,,13501.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10337.04,,,10969.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,6960.27,,,10969.92,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12938.88,,,12938.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6891.36,,,7167.01,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,11954.4,,,11954.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13360.8,,,12657.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12657.6,,,13360.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,6891.36,,,6891.36,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,10969.92,13501.44,
HC TIBIA FIXED RIGHT SIZE H NON-POROUS,Sx42-5420-083,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,15300,13770,14535,,,13770,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11934,,,11934,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13770,,,12735.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13770,,,7796.88,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13770,,,12735.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7497,,,7796.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13770,,,13770,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14688,,,14688,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11245.5,,,11934,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7571.97,,,11934,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14076,,,14076,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7497,,,7796.88,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13005,,,13005,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14535,,,13770,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13770,,,14535,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7497,,,7497,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11934,14688,
ALTEPLASE FOR INJ 100 MG,Rx50242008527,CDM,J2997,HCPCS,636,RC,50242008527,NDC,,BOTH,100,ME,15326.17,13804.09,14559.86,,,13796.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11954.41,,,11957.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13793.55,,,12760.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13793.55,,,7811.93,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13793.55,,,12760.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7509.82,,,7811.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13793.55,,,13796.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14713.12,,,14716.35,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11264.73,,,11957.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7509.82,,,11957.03,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14100.08,,,14103.17,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7509.82,,,7811.93,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13027.24,,,13030.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14559.86,,,13796.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13793.55,,,14563.05,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7509.82,,,7509.82,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,11954.41,14713.12,
HC TALAR COMPONENT L SMALL,Sx0000400-255,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,15582,14023.8,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12153.96,,,12153.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,7940.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14958.72,,,14958.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11452.77,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.53,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14335.44,,,14335.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13244.7,,,13244.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14802.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7635.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12153.96,14958.72,
HC TALAR COMPONENT X SMALL,Sx0000400-253,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,15582,14023.8,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12153.96,,,12153.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,7940.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14958.72,,,14958.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11452.77,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.53,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14335.44,,,14335.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13244.7,,,13244.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14802.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7635.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12153.96,14958.72,
HC PLATE TALAR MED RIGHT 36X35MM IMPLANT,Sx0000400-256,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,15582,14023.8,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12153.96,,,12153.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,7940.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14958.72,,,14958.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11452.77,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.53,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14335.44,,,14335.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13244.7,,,13244.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14802.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7635.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12153.96,14958.72,
HC PLATE TALAR MED LEFT 36X35MM,Sx0000400-257,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,15582,14023.8,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12153.96,,,12153.96,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,7940.59,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,12970.46,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14958.72,,,14958.72,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11452.77,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7711.53,,,12153.96,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14335.44,,,14335.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7940.59,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13244.7,,,13244.7,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14802.9,,,14023.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14023.8,,,14802.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7635.18,,,7635.18,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12153.96,14958.72,
HC STEM EXTENSION 3MM OFFSET 14MM DIA +135MM LENGTH SPLINED,Sx42-5603-135,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,15600,14040,14820,,,14040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12168,,,12168,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14040,,,12985.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14040,,,7949.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14040,,,12985.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7644,,,7949.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14040,,,14040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14976,,,14976,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11466,,,12168,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7720.44,,,12168,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14352,,,14352,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7644,,,7949.76,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13260,,,13260,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14820,,,14040,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14040,,,14820,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7644,,,7644,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12168,14976,
HC TPRLC 133 MP TYPE1 PPS HO 11.0,Sx0051-107110,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,15705,14134.5,14919.75,,,14134.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12249.9,,,12249.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14134.5,,,13072.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14134.5,,,8003.27,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14134.5,,,13072.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695.45,,,8003.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14134.5,,,14134.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15076.8,,,15076.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11543.18,,,12249.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,7772.4,,,12249.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14448.6,,,14448.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695.45,,,8003.27,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13349.25,,,13349.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14919.75,,,14134.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14134.5,,,14919.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7695.45,,,7695.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12249.9,15076.8,
HC ALLOGRAFT HUMAN TISSUE EPIFIX 30SQCM 5CM X 6CM,Sx0000GS-5560,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,16186.5,14567.85,15377.18,,,14567.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12625.47,,,12625.47,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14567.85,,,13473.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14567.85,,,8248.64,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14567.85,,,13473.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7931.39,,,8248.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14567.85,,,14567.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15539.04,,,15539.04,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,11897.08,,,12625.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8010.7,,,12625.47,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14891.58,,,14891.58,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7931.39,,,8248.64,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13758.53,,,13758.53,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15377.18,,,14567.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14567.85,,,15377.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,7931.39,,,7931.39,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12625.47,15539.04,
VEDOLIZUMAB FOR IV SOLUTION 300 MG,Rx64764030020,CDM,J3380,HCPCS,636,RC,64764030020,NDC,,BOTH,300,ME,16384.17,13911.08,15564.96,,,14745.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12779.65,,,12779.66,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14745.75,,,13638.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14745.75,,,8349.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14745.75,,,13638.19,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8028.24,,,8349.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,14745.75,,,14745.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15728.8,,,15728.81,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12042.36,,,12779.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8028.24,,,12779.66,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15073.44,,,15073.45,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8028.24,,,8349.38,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13926.54,,,13926.55,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15564.96,,,14745.76,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14745.75,,,15564.97,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8028.24,,,8028.24,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,12779.65,15728.8,
HC PLATE TIBIAL 45MM SBI IMPLANT,Sx0000400-264,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,17895,16105.5,17000.25,,,16105.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13958.1,,,13958.1,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16105.5,,,14895.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16105.5,,,9119.29,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16105.5,,,14895.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8768.55,,,9119.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16105.5,,,16105.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17179.2,,,17179.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13152.83,,,13958.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,8856.24,,,13958.1,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16463.4,,,16463.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8768.55,,,9119.29,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,15210.75,,,15210.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17000.25,,,16105.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16105.5,,,17000.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,8768.55,,,8768.55,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,13958.1,17179.2,
HC PARTIAL KNEE SET 3 ITEMS LISTED ON PO COMMENTS,Sx98-B002-006,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,19500,17550,18525,,,17550,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15210,,,15210,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17550,,,16231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17550,,,9937.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17550,,,16231.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9555,,,9937.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17550,,,17550,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18720,,,18720,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14332.5,,,15210,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9650.55,,,15210,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17940,,,17940,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9555,,,9937.2,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16575,,,16575,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18525,,,17550,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17550,,,18525,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9555,,,9555,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15210,18720,
HC PLATE TIBIAL 35MM MEDIUM TIBIA PLATE IMPLANT,Sx0000400-262,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,19605,12657.6,18624.75,,,17644.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15291.9,,,15291.9,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17644.5,,,16319.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17644.5,,,9990.71,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17644.5,,,16319.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9606.45,,,9990.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17644.5,,,17644.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18820.8,,,18820.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14409.68,,,15291.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9702.51,,,15291.9,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18036.6,,,18036.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9606.45,,,9990.71,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16664.25,,,16664.25,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18624.75,,,17644.5,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17644.5,,,18624.75,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9606.45,,,9606.45,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15291.9,18820.8,
HC PLATE TALAR SM RIGHT 34X35MM IMPLANT,Sx0000400-254,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,19827,17844.3,18835.65,,,17844.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15465.06,,,15465.06,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17844.3,,,16504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17844.3,,,10103.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17844.3,,,16504,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9715.23,,,10103.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,17844.3,,,17844.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19033.92,,,19033.92,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,14572.85,,,15465.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,9812.38,,,15465.06,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18240.84,,,18240.84,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9715.23,,,10103.84,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,16852.95,,,16852.95,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18835.65,,,17844.3,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,17844.3,,,18835.65,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,9715.23,,,9715.23,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,15465.06,19033.92,
HC PLATE TALAR LARGE,Sx0000400-258,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,21720,14023.8,20634,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16941.6,,,16941.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,18079.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,11068.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,18079.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,11068.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20851.2,,,20851.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15964.2,,,16941.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10749.23,,,16941.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19982.4,,,19982.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,11068.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18462,,,18462,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20634,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,20634,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,10642.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16941.6,20851.2,
HC PLATE TALAR X-LARGE,Sx0000400-259,CDM,C1713,HCPCS,278,RC,,,,BOTH,,,21720,14023.8,20634,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,16941.6,,,16941.6,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,18079.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,11068.51,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,18079.73,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,11068.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20851.2,,,20851.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,15964.2,,,16941.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,10749.23,,,16941.6,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,19982.4,,,19982.4,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,11068.51,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,18462,,,18462,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,20634,,,19548,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19548,,,20634,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,10642.8,,,10642.8,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,16941.6,20851.2,
HC CARTIFORM GRAFT,SxABS-1101-20,CDM,C1776,HCPCS,278,RC,,,,BOTH,,,25500,22950,24225,,,22950,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19890,,,19890,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22950,,,21226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22950,,,12994.8,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22950,,,21226.2,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12495,,,12994.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,22950,,,22950,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24480,,,24480,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,18742.5,,,19890,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,12619.95,,,19890,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23460,,,23460,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12495,,,12994.8,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,21675,,,21675,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24225,,,22950,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,22950,,,24225,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,12495,,,12495,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,19890,24480,
HC ALLOGRAFT HUMAN TISSUE EPIFIX 49SQCM 7CM X 7CM,Sx0000GS-5770,CDM,C1781,HCPCS,278,RC,,,,BOTH,,,27076.5,24368.85,25722.68,,,24368.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,21119.67,,,21119.67,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24368.85,,,22538.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24368.85,,,13798.18,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24368.85,,,22538.48,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13267.49,,,13798.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24368.85,,,24368.85,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25993.44,,,25993.44,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,19901.23,,,21119.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,13400.16,,,21119.67,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,24910.38,,,24910.38,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13267.49,,,13798.18,percent of total billed charges,One or more instances of the item or service in the 12 months prior to posting the file,23015.03,,,23015.03,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,25722.68,,,24368.86,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,24368.85,,,25722.68,PERCENT OF TOTAL BILLED CHARGES,One or more instances of the item or service in the 12 months prior to posting the file,13267.49,,,13267.49,percent of total billed charges,Zero Instances of Item of service in the 12 months prior to posting the file,21119.67,25993.44,